Provider Demographics
NPI:1487000493
Name:DIGITAL MAMMOGRAPHY SPECIALISTS - MOBILE, LLC.
Entity type:Organization
Organization Name:DIGITAL MAMMOGRAPHY SPECIALISTS - MOBILE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-428-6107
Mailing Address - Street 1:12460 CRABAPPLE RD
Mailing Address - Street 2:SUITE 202-151
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6602
Mailing Address - Country:US
Mailing Address - Phone:404-692-3493
Mailing Address - Fax:
Practice Address - Street 1:12460 CRABAPPLE RD
Practice Address - Street 2:SUITE 202-151
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6602
Practice Address - Country:US
Practice Address - Phone:404-692-3493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography