# EXECUTIVE IMAGE INC

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

## Provider details

- **NPI number:** 1588759849
- **Authorized official:** MS. DIANA GOOLSBY (OWNER)
- **Authorized official phone:** (336) 918-6328

## Contact information

- **Practice address:** 7820 N POINT BLVD, SUITE 101, WINSTON SALEM, NC 27106-3299
- **Practice address phone:** (336) 245-0647
- **Practice address fax:** (336) 245-0649
- **Mailing address:** 7820 N POINT BLVD, SUITE 101, WINSTON SALEM, NC 27106-3299
- **Mailing address phone:** (336) 245-0647
- **Mailing address fax:** (336) 245-0649

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 600495328 | NC | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 01/15/2015