NPIMap

Organization Active NPI

American Health Imaging of Georgia LLC

Doing business as American Health Imaging of Canton LLC

  • Radiology Clinic/Center
  • Canton, GA
National Provider Identifier
1780937508
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
01587 Issued in GA
Legal business name
AMERICAN HEALTH IMAGING OF GEORGIA LLC
Doing business as
American Health Imaging of Canton LLC
Practice address
100 Liberty Blvd Ste 100
Canton, GA 30114-2841
Phone
(770) 479-1945
Fax
(770) 479-1948
NPI assigned
Oct 17, 2012
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Katrina Roelle
Title
Director of Credentialing
Phone
(614) 689-1691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 01587 GA Primary

Addresses

Primary practice location

100 Liberty Blvd Ste 100
Canton, GA 30114-2841

Mailing address

PO Box 745973
Atlanta, GA 30374-5973

Other names 1

  • American Health Imaging of Canton LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130411000297 GA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1557353877 Practice locations: Canton, GA

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2075795American Health Imaging of Canton100 Liberty Boulevard, Suite 100, Canton, GA 30114Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory

Locations

100 Liberty Blvd
Ste 100
Canton, GA 30114
Phone (770) 479-1945

Practitioners & affiliated clinicians

Practitioners 118

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.

View all 118

NPI Registry JSON

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1780937508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745973",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303745973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LIBERTY BLVD STE 100",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142841",
            "telephone_number": "770-479-1945",
            "fax_number": "770-479-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN HEALTH IMAGING OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "ROELLE",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "614-689-1691"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "GA",
            "license": "01587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Health Imaging of Canton LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "American Health Imaging of Canton LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.