Provider Demographics
NPI:1255153011
Name:ADVANCED DIAGNOSTIC IMAGING, PC
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-239-2027
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:980 PROFESSIONAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5251
Practice Address - Country:US
Practice Address - Phone:931-905-1001
Practice Address - Fax:931-905-1034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCD DIAGNOSTIC IMAGING, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies