Provider Demographics
NPI:1184650228
Name:MARSHALL RADIOLOGY PC
Entity type:Organization
Organization Name:MARSHALL RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-271-0100
Mailing Address - Street 1:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1164
Mailing Address - Country:US
Mailing Address - Phone:706-271-0100
Mailing Address - Fax:706-270-0487
Practice Address - Street 1:2505 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5908
Practice Address - Country:US
Practice Address - Phone:256-840-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529918000Medicaid
ALDA4610OtherRR MEDICARE
ALJ496Medicare ID - Type Unspecified