Provider Demographics
NPI:1023273646
Name:MDDC RADIOLOGY SERVICES
Entity type:Organization
Organization Name:MDDC RADIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-364-3918
Mailing Address - Street 1:3101 CLAIRMONT RD NE
Mailing Address - Street 2:SUITE-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1044
Mailing Address - Country:US
Mailing Address - Phone:404-982-7676
Mailing Address - Fax:
Practice Address - Street 1:3101 CLAIRMONT RD NE
Practice Address - Street 2:SUITE-A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1044
Practice Address - Country:US
Practice Address - Phone:404-982-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology