Provider Demographics
NPI:1174762702
Name:ATLANTIC COAST ECHOCARDIOGRAPHY AND SONOGRAPHY LLC.
Entity type:Organization
Organization Name:ATLANTIC COAST ECHOCARDIOGRAPHY AND SONOGRAPHY LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-830-6789
Mailing Address - Street 1:12587 FAIR LAKES CIR
Mailing Address - Street 2:SUITE# 276
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3822
Mailing Address - Country:US
Mailing Address - Phone:703-830-6789
Mailing Address - Fax:703-830-6790
Practice Address - Street 1:12587 FAIR LAKES CIR
Practice Address - Street 2:SUITE# 276
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3822
Practice Address - Country:US
Practice Address - Phone:703-830-6789
Practice Address - Fax:703-830-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty