Canton Specialty Imaging, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

051890 Issued in GA

Legal business name

CANTON SPECIALTY IMAGING, LLC

Practice address

200 Oakside LN
Suite a
Canton, GA 30114-6416

Phone

(770) 479-1945

Fax

(770) 479-1948

NPI assigned

Apr 6, 2011

Last updated

Apr 6, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bradley R Peters, M.D.

Title

Member/Medical Director

Phone

(770) 479-1945

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1457640831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OAKSIDE LN",
            "address_2": "SUITE A",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301146416",
            "telephone_number": "770-479-1945",
            "fax_number": "770-479-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OAKSIDE LN",
            "address_2": "SUITE A",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301146416",
            "telephone_number": "770-479-1945",
            "fax_number": "770-479-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON SPECIALTY IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-06",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-479-1945",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "051890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Canton, GA
• Providers in Canton, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.