Marietta Diagnostic Center, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

MARIETTA DIAGNOSTIC CENTER, LLC

Practice address

780 Canton Road NE
Suite 230
Marietta, GA 30060-8928

Phone

(770) 792-1234

Fax

(770) 424-1194

NPI assigned

May 12, 2006

Organization subpart

Yes

Parent organization

MARIETTA DIAGNOSTIC CENTER, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mike Evertseb

Title

Ceo

Phone

(770) 792-1234

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Marietta Imaging Center Marietta Imaging at North Cobb Doing business as

Part of

Marietta Diagnostic Cent

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anand P Lalaji, MD

  • Diagnostic Radiology Physician
  • Atlanta, GA
  • NPI 1649245747
  NPD (past)
• Earnest Chester Riley, M.D.

  • Specialist
  • Smyrna, GA
  • NPI 1881631869
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1154371805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 CANTON ROAD NE",
            "address_2": "SUITE 230",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608928",
            "telephone_number": "770-792-1234",
            "fax_number": "770-424-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 CANTON ROAD NE",
            "address_2": "SUITE 230",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608928",
            "telephone_number": "770-792-1234",
            "fax_number": "770-424-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIETTA DIAGNOSTIC CENTER, LLC",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "EVERTSEB",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-792-1234",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "764269020A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marietta Imaging Center Marietta Imaging at North Cobb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marietta Counseling Practice
• Marietta Dental Associates.Inc
• Marietta Dental Smiles
• Marietta Dentist
• Marietta Dermatology Associates PA
• Marietta Eye Clinic, PA
• Marietta Eye Clinic, PA
• Marietta Eye Clinic, PA
• Marietta Eye Clinic, PA
• Marietta Eye Clinic, PA

• Diagnostic Radiology Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Diagnostic Radiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.