Organization Active NPI

Women's Imaging Specialists - Gwinnett, LLC

  • Mammography Clinic/Center
  • Lawrenceville, GA
National Provider Identifier
1639721376
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
Legal business name
WOMEN'S IMAGING SPECIALISTS - GWINNETT, LLC
Practice address
601A Professional Drive
Suite 160
Lawrenceville, GA 30045
Phone
(866) 300-8512
Fax
(800) 613-8386
NPI assigned
Jul 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Jennifer L ReddyNPI 1407303332
Title
Manager
Phone
(404) 692-3493

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

601A Professional Drive
Suite 160
Lawrenceville, GA 30045

Mailing address

3180 N Point Pkwy Ste 106
Alpharetta, GA 30005-4349
Phone (866) 300-8512

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200330000792 GA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1254760127 Practice locations: Lawrenceville, GA

National Provider Directory

National Provider Directory

Locations

601 Professional Dr
Ste 160
Lawrenceville, GA 30046
Phone (678) 376-4242

Practitioners & affiliated clinicians

Practitioners 7

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": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1639721376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 N POINT PKWY STE 106",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054349",
            "telephone_number": "866-300-8512",
            "fax_number": "800-613-8386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601A PROFESSIONAL DRIVE",
            "address_2": "SUITE 160",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30045",
            "telephone_number": "866-300-8512",
            "fax_number": "800-613-8386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOMEN'S IMAGING SPECIALISTS - GWINNETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-12",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-692-3493"
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.