NPIMap

Organization Active NPI

Children's Diagnostic Imaging of Atlanta

  • Pediatric Radiology Physician
  • Atlanta, GA
National Provider Identifier
1972555662
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Radiology PhysicianTaxonomy code 2085P0229X
Legal business name
CHILDREN'S DIAGNOSTIC IMAGING OF ATLANTA
Practice address
1001 Johnson Ferry Rd NE
Atlanta, GA 30342-1605
Phone
(404) 785-2162
NPI assigned
May 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jennifer Broyles
Title
Credentialing
Phone
(770) 779-2168

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Radiology Physician 2085P0229X NU Primary

Addresses

Primary practice location

1001 Johnson Ferry Rd NE
Atlanta, GA 30342-1605

Mailing address

PO Box 2936
Kennesaw, GA 30156-9116
Phone (770) 779-0010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080414000433 GA Part B Supplier - Clinic/Group Practice 2365529419 Receives reassigned benefits from 8 practitioners
Practice locations: Alpharetta, GA; Atlanta, GA

National Provider Directory

National Provider Directory

Locations

3155 North Point Pkwy
Ste A100
Alpharetta, GA 30005
Phone (404) 785-8570

Practitioners & affiliated clinicians

Practitioners 9

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972555662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2936",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301569116",
            "telephone_number": "770-779-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 JOHNSON FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421605",
            "telephone_number": "404-785-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DIAGNOSTIC IMAGING OF ATLANTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROYLES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "770-779-2168"
    },
    "taxonomies": [
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.