Open MRI of Brunswick LLC

Primary specialty

Magnetic Resonance Imaging Radiologic TechnologistTaxonomy code 2471M1202X

License

031432 Issued in GA

Legal business name

OPEN MRI OF BRUNSWICK LLC

Practice address

2414 Parkwood Dr
Suite 100
Brunswick, GA 31520-4779

Phone

(770) 451-4040

Fax

(770) 451-3003

NPI assigned

Jan 14, 2009

Last updated

Jun 18, 2012By 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

Anthony K Gordon, M.D.

Title

Owner

Phone

(770) 451-4040

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1972740884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414B PARKWOOD DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204721",
            "telephone_number": "770-451-4040",
            "fax_number": "770-451-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2414 PARKWOOD DR",
            "address_2": "SUITE 100",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204779",
            "telephone_number": "770-451-4040",
            "fax_number": "770-451-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN MRI OF BRUNSWICK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-14",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-451-4040",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2471M1202X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": "GA",
            "license": "031432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000449765AC",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER",
            "identifier": "202I300099",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Magnetic Resonance Imaging Radiologic Technologist in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Magnetic Resonance Imaging Radiologic Technologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.