Provider Demographics
NPI:1013956416
Name:MEDICA IMAGING, LLC
Entity Type:Organization
Organization Name:MEDICA IMAGING, LLC
Other - Org Name:MEDICA FORSYTH OPEN MRI & CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-354-6766
Mailing Address - Street 1:925 SANDERS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7945
Mailing Address - Country:US
Mailing Address - Phone:678-845-2150
Mailing Address - Fax:678-845-2148
Practice Address - Street 1:925 SANDERS RD
Practice Address - Street 2:SUITE B
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7945
Practice Address - Country:US
Practice Address - Phone:678-845-2150
Practice Address - Fax:678-845-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2100666261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAX60956Medicare UPIN
GA47BBBDSMedicare ID - Type UnspecifiedMEDICARE IDTF NUMBER