Organization
JACKSONVILLE DIAGNOSTIC IMAGING LLC
Active
Other names
Coastal Diagnostic Imaging
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
3606 HENDERSON DR, JACKSONVILLE, NC 28546-5217
(910) 937-7226
(910) 937-0064
Mailing address
PO BOX 933393, ATLANTA, GA 31193-0001
(866) 659-1211
(336) 774-1751
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014UN
BCBS NC
NC
01
—
101136600
DOL
NC
05
—
89014UN
—
NC
01
—
P00107621
MEDICARE RAILROAD
NC
Enumeration date
05/04/2006
Last updated
03/19/2024
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