Organization
MECKLENBURG DIAGNOSTIC IMAGING LLC
Active
Other names
Novant Health Imaging Southpark
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY K. GARDNER (SVP FINANCE AND REVENUE CYCLE)
(336) 718-2078
Entity
Organization
Contact information
Practice address
6324 FAIRVIEW RD, SUITE 120 A, CHARLOTTE, NC 28210-3200
(704) 362-8444
(704) 362-3557
Mailing address
PO BOX 603543, CHARLOTTE, NC 28260-3543
(678) 393-5600
(770) 300-9018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01514
BCBS NC
NC
01
—
153718700
DOL
NC
05
—
6901514
—
NC
05
—
NPB300
—
SC
01
—
P00315955
MEDICARE RR
—
05
—
SL0083
—
SC
Enumeration date
05/03/2006
Last updated
03/19/2024
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