# WACCAMAW IMAGING, LLC

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

## Provider details

- **NPI number:** 1770891103
- **Authorized official:** ANTHONY GRIGSBY (MANAGER)
- **Authorized official phone:** (910) 646-1452

## Contact information

- **Practice address:** 3806 PEACHTREE AVE, WILMINGTON, NC 28403-6751
- **Practice address phone:** (910) 646-1452
- **Mailing address:** 112 E WHITE OAK ST, LAKE WACCAMAW, NC 28450-2128
- **Mailing address phone:** (910) 646-1452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0208X | Mobile Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/20/2010
- **Last updated:** 09/20/2010