Organization
GEORGE REGIONAL RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY FENDER (ADMINISTRATOR)
(601) 947-8181
Entity
Organization
Contact information
Practice address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 947-8181
Mailing address
PO BOX 628, LUCEDALE, MS 39452
(601) 947-8181
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19622
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
512G700430
MEDICARE PTAN
MS
01
—
P00684671
PALMETTO GBA MCARE
MS
Enumeration date
10/16/2008
Last updated
12/30/2010
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