Provider Demographics
NPI:1982960787
Name:GREATER GEORGIA RADIOLOGY
Entity Type:Organization
Organization Name:GREATER GEORGIA RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-433-0717
Mailing Address - Street 1:2002 SUMMIT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1560
Mailing Address - Country:US
Mailing Address - Phone:404-433-0717
Mailing Address - Fax:404-566-2301
Practice Address - Street 1:2002 SUMMIT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1560
Practice Address - Country:US
Practice Address - Phone:404-433-0717
Practice Address - Fax:404-566-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology