Organization
MED VENTURES MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD P. HOLLSTROM JR. DPM (AUTHORIZED OFFICIAL)
(706) 594-0687
Entity
Organization
Contact information
Practice address
1075 LAFAYETTE PARKWAY, STE 120, LAGRANGE, GA 30241
(706) 845-9370
(706) 845-9371
Mailing address
1975 HWY 54 W., STE 205, PEACHTREE CITY, GA 30269-4794
(678) 561-9000
(770) 487-1232
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
GA
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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