NPIMap

Organization Active NPI

South Gwinnett Radiology PC

  • Diagnostic Radiology Physician
  • Snellville, GA
National Provider Identifier
1740232677
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SOUTH GWINNETT RADIOLOGY PC
Practice address
1700 Medical Way
Snellville, GA 30078
Phone
(770) 979-0200
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Authorized official

Name
Charlotte A Hayes, MDNPI 1043284615
Title
Radiologist
Phone
(770) 979-0200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1700 Medical Way
Snellville, GA 30078

Mailing address

PO Box 116075
Atlanta, GA 30368
Phone (855) 709-1801

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041201000165 GA Part B Supplier - Clinic/Group Practice 5496710493 Receives reassigned benefits from 11 practitioners
Practice locations: Loganville, GA; Snellville, GA

National Provider Directory

National Provider Directory

Locations

3445 Highway 81
Loganville, GA 30052
Phone (678) 639-0415

1700 Tree Ln
Ste 100
Snellville, GA 30078
Phone (770) 736-2551

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1740232677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116075",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30368",
            "telephone_number": "855-709-1801",
            "fax_number": "610-373-2308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MEDICAL WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "30078",
            "telephone_number": "770-979-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GWINNETT RADIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "770-979-0200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; 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.