Provider Demographics
NPI:1952419012
Name:SOUTH GEORGIA RADIOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:SOUTH GEORGIA RADIOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-737-4575
Mailing Address - Street 1:P.O. BOX 3201
Mailing Address - Street 2:1125 TROUPE STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3201
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:5843 DEOSTA DR
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-3405
Practice Address - Country:US
Practice Address - Phone:229-259-4888
Practice Address - Fax:229-559-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085B0100X, 2085D0003X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0204X, 2085U0001X
GA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447200399OtherNPI - MICHAEL MILLNER, MD
157743000OtherACS DOL
157743000OtherACS DOL