# DANWANTRY MEDICAL & IMAGING SERVICES, LLC

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

## Provider details

- **NPI number:** 1356559322
- **Authorized official:** DR. RAGHAVA A. BHASKARAN M.D. (PHYSICIAN)
- **Authorized official phone:** (478) 998-1471

## Contact information

- **Practice address:** 4961 BUFORD HWY, SUITE 102, CHAMBLEE, GA 30341-3503
- **Practice address phone:** (478) 998-1471
- **Mailing address:** PO BOX 1527, DUBLIN, GA 31040-1527
- **Mailing address phone:** (478) 274-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | 025580 | GA | — |
| 2085N0904X | Nuclear Radiology Physician | 025580 | GA | — |
| 2085R0202X | Diagnostic Radiology Physician | 025580 | GA | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | 025580 | GA | — |
| 2085U0001X | Diagnostic Ultrasound Physician | 025580 | GA | — |
| 208D00000X | General Practice Physician | 025580 | GA | Yes |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 11/23/2011