Provider Demographics
NPI:1972069268
Name:OMEGA PROFESSIONAL RADIOLOGY SERVICES OF GEORGIA LLC
Entity Type:Organization
Organization Name:OMEGA PROFESSIONAL RADIOLOGY SERVICES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-373-7383
Mailing Address - Street 1:3333 OLD MILTON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4437
Mailing Address - Country:US
Mailing Address - Phone:815-307-4850
Mailing Address - Fax:
Practice Address - Street 1:3333 OLD MILTON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4437
Practice Address - Country:US
Practice Address - Phone:985-373-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty