# SNELLIVLLE MEDICAL IMAGING

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

## Provider details

- **NPI number:** 1205886249
- **Authorized official:** KENDAL COWAN (NUCLEAR MEDICINE TECHNOLOGIST)
- **Authorized official phone:** (678) 205-2555

## Contact information

- **Practice address:** 2310 HENRY CLOWER BLVD, SUITE A, SNELLVILLE, GA 30078-5776
- **Practice address phone:** (678) 205-2555
- **Practice address fax:** (678) 205-2556
- **Mailing address:** 2310 HENRY CLOWER BLVD, SUITE A, SNELLVILLE, GA 30078-5776
- **Mailing address phone:** (678) 205-2555
- **Mailing address fax:** (678) 205-2556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 2006OCC0013 | GA | Yes |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 08/22/2020