# VIDALIA OPEN MRI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164599353
- **Authorized official:** MR. FRANK HARRELSON JR. (OFFICE MANAGER)
- **Authorized official phone:** (800) 474-1077

## Contact information

- **Practice address:** 3165 E 1ST ST, VIDALIA, GA 30474-8830
- **Practice address phone:** (800) 474-1077
- **Mailing address:** 3165 E 1ST ST, VIDALIA, GA 30474-8830
- **Mailing address phone:** (800) 474-1077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2471M1202X | Magnetic Resonance Imaging Radiologic Technologist | 025199 | GA | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 08/17/2007