Organization
ADVANCED DIAGNOSTIC IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA G WAYSTACK (CEO)
(803) 534-0053
Entity
Organization
Contact information
Practice address
1728 VILLAGE PARK DR, ORANGEBURG, SC 29118-2426
(803) 534-0053
(803) 536-1198
Mailing address
PO BOX 2729, ORANGEBURG, SC 29116-2729
(803) 534-0053
(803) 536-1198
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN8540
MEDICARE RAILROAD
GA
Enumeration date
11/16/2006
Last updated
11/08/2010
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