# SOURCE DIAGNOSTICS OF GEORGIA, LLC

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

## Provider details

- **NPI number:** 1700190105
- **Authorized official:** MS. KATHLEEN A BARRY (COO)
- **Authorized official phone:** (440) 645-7822

## Contact information

- **Practice address:** 5559 THOMASTON RD, MACON, GA 31220-8120
- **Practice address phone:** (478) 405-7015
- **Mailing address:** 5275 NAIMAN PKWY, SUITE E, SOLON, OH 44139-1029
- **Mailing address phone:** (440) 542-1515

## Taxonomy

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

## Other

- **Enumeration date:** 07/28/2010
- **Last updated:** 03/28/2012