Provider Demographics
NPI:1518794387
Name:WOMEN'S IMAGING SPECIALISTS - EAGLES WALK, LLC
Entity type:Organization
Organization Name:WOMEN'S IMAGING SPECIALISTS - EAGLES WALK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-300-8512
Mailing Address - Street 1:5900 WINDWARD PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8861
Mailing Address - Country:US
Mailing Address - Phone:866-300-8512
Mailing Address - Fax:800-613-8386
Practice Address - Street 1:135 EAGLES WALK STE 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7391
Practice Address - Country:US
Practice Address - Phone:866-300-8512
Practice Address - Fax:800-889-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography