Valdosta Imaging Center Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

VALDOSTA IMAGING CENTER INC

Practice address

704 Gil Harbin Industrial Blvd
Ste a
Valdosta, GA 31601-6513

Phone

(229) 242-8790

Fax

(229) 247-6868

NPI assigned

Nov 15, 2013

Last updated

Nov 15, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Travis S Graham

Title

Ceo

Phone

(229) 242-8790

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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.

• Lloyd David Wagner, M.D.

  • Diagnostic Radiology Physician
  • Camden, NJ
  • NPI 1124161872

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1831529536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "LAKE PARK",
            "state": "GA",
            "postal_code": "316360400",
            "telephone_number": "229-242-8790",
            "fax_number": "229-247-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 GIL HARBIN INDUSTRIAL BLVD",
            "address_2": "STE A",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316016513",
            "telephone_number": "229-242-8790",
            "fax_number": "229-247-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALDOSTA IMAGING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-242-8790"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valdosta Foot & Ankle Clinic, P.C.
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• Valdosta Gastroenterology Associates, LLC
• Valdosta Health & Wellness Clinic Inc
• Valdosta Healthcare Club
• Valdosta Kidney Clinic, LLC
• Valdosta Medical Associates
• Valdosta Medical Clinic
• Valdosta Oral and Maxillofacial Surgeons
• Valdosta Orthopedic Associates PC (Valdosta Orthopedic Associates)

• Diagnostic Radiology Physician in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Diagnostic Radiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; 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.