Organization Active NPI

Digital Mammography Specialists - Conyers, LLC

  • Mammography Clinic/Center
  • Conyers, GA
National Provider Identifier
1255619441
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
Legal business name
DIGITAL MAMMOGRAPHY SPECIALISTS - CONYERS, LLC
Practice address
3242 Avalon Blvd.
Conyers, GA 30013
Phone
(678) 904-6823
Fax
(678) 904-6824
NPI assigned
Jul 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Authorized official

Name
Dr. Manju Morrissey, M.D.
Title
Ceo
Phone
(866) 917-2806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X Primary

Addresses

Primary practice location

3242 Avalon Blvd.
Conyers, GA 30013

Mailing address

3242 Avalon Blvd
Conyers, GA 30013-6320
Phone (678) 904-6823

Other names 1

  • DMS - Conyers Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111121000392 GA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4284808635 Practice locations: Conyers, GA

National Provider Directory

National Provider Directory

Locations

200 Arizona Ave NE
Ste 200
Atlanta, GA 30307
Phone (678) 904-6820

3242 Avalon Blvd
Conyers, GA 30013
Phone (678) 904-6823

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1255619441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3242 AVALON BLVD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136320",
            "telephone_number": "678-904-6823",
            "fax_number": "770-679-1425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3242 AVALON BLVD.",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30013",
            "telephone_number": "678-904-6823",
            "fax_number": "678-904-6824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGITAL MAMMOGRAPHY SPECIALISTS - CONYERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-22",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "MORRISSEY",
        "authorized_official_first_name": "MANJU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "866-917-2806",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DMS - Conyers",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "DMS - Conyers",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.