Organization
MARIETTA DIAGNOSTIC CENTER, LLC
Active
Parent organization
MARIETTA DIAGNOSTIC CENTER, LLC
Other names
Marietta Imaging Center Marietta Imaging at North Cobb
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARIETTA DIAGNOSTIC CENTER, LLC
Authorized official
MR. MIKE EVERTSEB (CEO)
(770) 792-1234
Entity
Organization
Contact information
Practice address
780 CANTON ROAD NE, SUITE 230, MARIETTA, GA 30060-8928
(770) 792-1234
(770) 424-1194
Mailing address
780 CANTON ROAD NE, SUITE 230, MARIETTA, GA 30060-8928
(770) 792-1234
(770) 424-1194
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
764269020A
—
GA
Enumeration date
05/12/2006
Last updated
04/25/2013
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