Southeast Georgia Open MRI LLC
Organization Active NPI Diagnostic Radiology Physician · Brunswick, GA
NPI 1255438974 · NPPES record last updated Jan 27, 2012
Key facts
- NPI
- 1255438974
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- SOUTHEAST GEORGIA OPEN MRI LLC
- Practice address
- 1103 Fountain Lake Drive
Brunswick, GA 31525 - Phone
- (912) 267-6736
- Fax
- (912) 262-1922
- NPI assigned
- Sep 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Caroline Harris
- Title
- Account Director
- Phone
- (912) 267-6736
National Provider Directory
Locations
1103 Fountain Lake Dr
Brunswick, GA 31525
Phone (912) 267-6736
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
1103 Fountain Lake Drive
Brunswick, GA 31525
Mailing address
1103 Fountain Lake Drive
Brunswick, GA 31525
Phone (912) 267-6736
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00469169G | Medicaid | GA | |
| 1942294848 | Other | BILLING PROVIDER NUMBER |
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- Southeast Georgia Urology Associates PC
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- Southeast Second Chance, Inc
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All providers in Brunswick, GA · Diagnostic Radiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.