Med Ventures MRI, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

MED VENTURES MRI, LLC

Practice address

1075 Lafayette Parkway
Ste 120
Lagrange, GA 30241

Phone

(706) 845-9370

Fax

(706) 845-9371

NPI assigned

Apr 5, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Richard P. Hollstrom Jr., DPM

Title

Authorized Official

Phone

(706) 594-0687

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1154784205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 HWY 54 W.",
            "address_2": "STE 205",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694794",
            "telephone_number": "678-561-9000",
            "fax_number": "770-487-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 LAFAYETTE PARKWAY",
            "address_2": "STE 120",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "30241",
            "telephone_number": "706-845-9370",
            "fax_number": "706-845-9371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED VENTURES MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "HOLLSTROM",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "706-594-0687",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane L McGowan, M.D.
• James P McGowan, M.D.
• Michelle Denise McMickin
• Darrell L McMullen Sr., CASE MANAGER
• Keisha McNeill, MS, LPC
• Medical Care of Lagrange, LLC
• Medventures Physical Therapy, LLC
• Erin Meeks, MD
• Ryan Meeks, PHARMD
• Mental Health Services of Georgia

• Diagnostic Radiology Physician in Lagrange, GA
• Providers in Lagrange, 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 5, 2016; 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.