Radiology Assoc of South Ga, P.C.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

RADIOLOGY ASSOC OF SOUTH GA, P.C.

Practice address

1101 Ocilla Rd
Douglas, GA 31533-2207

Phone

(912) 384-1900

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Vickie Merritt

Title

Account Manager

Phone

(912) 384-6803

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1548471030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BOWENS MILL RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332250",
            "telephone_number": "912-384-6803",
            "fax_number": "912-383-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332207",
            "telephone_number": "912-384-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY ASSOC OF SOUTH GA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "MERRITT",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "912-384-6803",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300030604A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.