Provider Demographics
NPI:1912107616
Name:KING DIAGNOSTIC ULTRASOUND SERVICE
Entity Type:Organization
Organization Name:KING DIAGNOSTIC ULTRASOUND SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEDEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-840-9548
Mailing Address - Street 1:3483 ALBATROSS COURT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4206
Mailing Address - Country:US
Mailing Address - Phone:404-840-9548
Mailing Address - Fax:
Practice Address - Street 1:3483 ALBATROSS COURT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4206
Practice Address - Country:US
Practice Address - Phone:404-840-9548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile