Provider Demographics
NPI:1669430971
Name:CAROLINA IMAGING LLC OF FAYETTEVILLE
Entity type:Organization
Organization Name:CAROLINA IMAGING LLC OF FAYETTEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE AND REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-718-2078
Mailing Address - Street 1:PO BOX 933393
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-0001
Mailing Address - Country:US
Mailing Address - Phone:866-659-1211
Mailing Address - Fax:336-774-1751
Practice Address - Street 1:3628 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4406
Practice Address - Country:US
Practice Address - Phone:910-483-1321
Practice Address - Fax:910-323-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890108TMedicaid
NC153417000OtherDOL
P00450149OtherMEDICARE RAILROAD
NC0108TOtherBCBS NC
NC0108TOtherBCBS NC
NC=========001OtherTRICARE