Provider Demographics
NPI:1356559322
Name:DANWANTRY MEDICAL & IMAGING SERVICES, LLC
Entity type:Organization
Organization Name:DANWANTRY MEDICAL & IMAGING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHAVA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BHASKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-998-1471
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1527
Mailing Address - Country:US
Mailing Address - Phone:478-274-1100
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3503
Practice Address - Country:US
Practice Address - Phone:478-998-1471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0255802085B0100X, 2085N0904X, 2085R0202X, 2085R0204X, 2085U0001X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty