Provider Demographics
NPI:1023410842
Name:THE PINK RIBBON MAMMOGRAPHY AND DIAGNOSTIC RADIOLOGY SERVICES LLC
Entity type:Organization
Organization Name:THE PINK RIBBON MAMMOGRAPHY AND DIAGNOSTIC RADIOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARRIEM
Authorized Official - Suffix:
Authorized Official - Credentials:BS RT R, M, CT
Authorized Official - Phone:678-903-5798
Mailing Address - Street 1:256 VALLEY VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-9806
Mailing Address - Country:US
Mailing Address - Phone:678-903-5786
Mailing Address - Fax:888-545-1070
Practice Address - Street 1:256 VALLEY VIEW CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-9806
Practice Address - Country:US
Practice Address - Phone:678-903-5786
Practice Address - Fax:888-545-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0208X
GA326204335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile