Provider Demographics
NPI:1174785240
Name:DIGITAL MAMMOGRAPHY SPECIALISTS-EAGLES LANDING, LLC
Entity type:Organization
Organization Name:DIGITAL MAMMOGRAPHY SPECIALISTS-EAGLES LANDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJU
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-904-6820
Mailing Address - Street 1:200 ARIZONA AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2299
Mailing Address - Country:US
Mailing Address - Phone:678-904-6820
Mailing Address - Fax:678-904-6824
Practice Address - Street 1:115 EAGLE SPRING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6486
Practice Address - Country:US
Practice Address - Phone:678-904-7209
Practice Address - Fax:770-507-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography