# DIAGNOSTIC RADIOLOGY ASSOCIATES, PA

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

## Provider details

- **NPI number:** 1407860315
- **Authorized official:** MR. JEFFREY SCOTT FORTSON (OPERATIONS MANAGER)
- **Authorized official phone:** (770) 590-3848

## Contact information

- **Practice address:** 1050 N FLOWOOD DR, SUITE A-4, FLOWOOD, MS 39232-9738
- **Practice address phone:** (601) 936-0494
- **Mailing address:** PO BOX 4710, JACKSON, MS 39296-4710
- **Mailing address phone:** (601) 936-0494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | — | MS | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 02/26/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09011383 | — | MS |
| 01 | — | CL2516 | RR MEDICARE | MS |