Organization
VIDALIA OPEN MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANK HARRELSON JR. (OFFICE MANAGER)
(800) 474-1077
Entity
Organization
Contact information
Practice address
3165 E 1ST ST, VIDALIA, GA 30474-8830
(800) 474-1077
Mailing address
3165 E 1ST ST, VIDALIA, GA 30474-8830
(800) 474-1077
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
025199
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000303751E
—
GA
Enumeration date
11/30/2006
Last updated
08/17/2007
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