Individual
IVY GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(770) 567-7500
Mailing address
122 KATY LAKE RD, JACKSON, GA 30233-3396
(248) 331-6813
Taxonomy
Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
322854
GA
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
322854
GA
Other
Enumeration date
03/19/2026
Last updated
03/19/2026
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