American Health Imaging of Georgia LLC

Organization Active NPI Radiology Clinic/Center · Canton, GA

NPI 1780937508 · NPPES record last updated Jul 18, 2024

Key facts

NPI
1780937508
Entity type
Organization (NPI type 2)
Primary specialty
Radiology Clinic/Center 261QR0200X
License
01587 (GA)
Legal business name
AMERICAN HEALTH IMAGING OF GEORGIA 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
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 16

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

Practitioners 112

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

View all 112

Laboratory certificates & supplier records

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

CLIA laboratory certificates

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

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

National Provider Directory

Locations

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

Specialties & licenses

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

Addresses

Primary practice location

100 Liberty Blvd Ste 100
Canton, GA 30114-2841

Mailing address

PO Box 745973
Atlanta, GA 30374-5973

Other names

  • American Health Imaging of Canton LLC Doing business as

Other providers in Canton, GA

All providers in Canton, GA · Radiology Clinic/Center in Georgia

Sources for this page

Verify at the official NPI Registry.