NPIMap

Organization Active NPI

Diagnostic Imaging Specialists PA

  • Diagnostic Radiology Physician
  • Atlanta, GA
National Provider Identifier
1366424947
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DIAGNOSTIC IMAGING SPECIALISTS PA
Practice address
303 Parkway Dr NE
Atlanta, GA 30312
Phone
(404) 265-4000
NPI assigned
Nov 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

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

Authorized official

Name
Dr. Thomas Fuller, MD
Title
President
Phone
(404) 459-8440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

303 Parkway Dr NE
Atlanta, GA 30312

Mailing address

PO Box 591
Columbus, GA 31902-0500
Phone (706) 653-1102

Other identifiers 1

IdentifierTypeStateIssuer
CA0881OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040412000946 GA Part B Supplier - Clinic/Group Practice 8123012366 Receives reassigned benefits from 19 practitioners
Practice locations: Conyers, GA; Tybee Island, GA; Lawrenceville, GA; Fayetteville, GA; Decatur, GA; Atlanta, GA
O20180918001109 AZ Part B Supplier - Clinic/Group Practice 8123012366 Receives reassigned benefits from 2 practitioners
Practice locations: Prescott, AZ; Scottsdale, AZ

National Provider Directory

National Provider Directory

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

1190 W Druid Hills Dr NE
Ste T75
Brookhaven, GA 30329

2774 N Decatur Rd
Decatur, GA 30033
Phone (404) 292-2277

340 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 265-4000

481 W Pike St
Lawrenceville, GA 30046
Phone (678) 376-3550

6000 Lake Forrest Dr
Ste 425
Sandy Springs, GA 30328

7454 Hannover Pkwy S
Ste 235
Stockbridge, GA 30281
Phone (229) 598-6660

Practitioners & affiliated clinicians

Practitioners 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1366424947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 591",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319020500",
            "telephone_number": "706-653-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 PARKWAY DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30312",
            "telephone_number": "404-265-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC IMAGING SPECIALISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-459-8440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CA0881",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; 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.