Organization Active NPI

Mt Pleasant Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Covington, GA
National Provider Identifier
1609848597
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MT PLEASANT RADIOLOGY ASSOCIATES LLC
Practice address
1118 Brown St SW
Covington, GA 30014-2326
Phone
(800) 879-6274
Fax
(770) 784-7283
NPI assigned
Feb 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Young S Song, MD
Title
President
Phone
(800) 879-6274

Specialties & licenses 1

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

Addresses

Primary practice location

1118 Brown St SW
Covington, GA 30014-2326

Mailing address

PO Box 1247
Covington, GA 30015-1247
Phone (800) 879-6274

Other identifiers 1

IdentifierTypeStateIssuer
GP3949MedicaidSC

National Provider Directory

National Provider Directory

Locations

1118 Brown St SW
Covington, GA 30014

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1609848597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1247",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300151247",
            "telephone_number": "800-879-6274",
            "fax_number": "770-784-7283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 BROWN ST SW",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300142326",
            "telephone_number": "800-879-6274",
            "fax_number": "770-784-7283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT PLEASANT RADIOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-879-6274",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3949",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.