Provider Demographics
NPI:1255619441
Name:DIGITAL MAMMOGRAPHY SPECIALISTS - CONYERS, LLC
Entity type:Organization
Organization Name:DIGITAL MAMMOGRAPHY SPECIALISTS - CONYERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-917-2806
Mailing Address - Street 1:3242 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6320
Mailing Address - Country:US
Mailing Address - Phone:678-904-6823
Mailing Address - Fax:770-679-1425
Practice Address - Street 1:3242 AVALON BLVD.
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:678-904-6823
Practice Address - Fax:678-904-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography