Provider Demographics
NPI:1336386770
Name:GEORGIA HEALTH IMAGING, LLC
Entity Type:Organization
Organization Name:GEORGIA HEALTH IMAGING, LLC
Other - Org Name:PROGRESSIVE HEALTH, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUDHWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS, RDMS
Authorized Official - Phone:678-924-0964
Mailing Address - Street 1:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-1168
Mailing Address - Country:US
Mailing Address - Phone:678-924-0964
Mailing Address - Fax:678-924-0965
Practice Address - Street 1:3653 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4107
Practice Address - Country:US
Practice Address - Phone:678-924-0964
Practice Address - Fax:678-924-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP8122Medicare PIN