Provider Demographics
NPI:1841635810
Name:MOBILE IMAGING SERVICES OF GEORGIA, LLC
Entity type:Organization
Organization Name:MOBILE IMAGING SERVICES OF GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-302-5270
Mailing Address - Street 1:108 OLYMPIA DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-302-5270
Mailing Address - Fax:478-302-5280
Practice Address - Street 1:108 OLYMPIA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3682
Practice Address - Country:US
Practice Address - Phone:478-302-5270
Practice Address - Fax:478-302-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile