Organization
GASTON RADIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JAX (CHIEF OPERATING OFFICER)
(704) 867-8021
Entity
Organization
Contact information
Practice address
620 SUMMIT CROSSING PL, STE 106, GASTONIA, NC 28054-2176
(704) 867-8021
(704) 864-4606
Mailing address
PO BOX 745431, ATLANTA, GA 30374-5431
(843) 449-5360
(706) 653-4711
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067971
AETNA HMO
—
01
—
01618
BLUE CROSS BLUE SHIELD NC
—
01
—
1702
PARTNERS
—
01
—
8381530
AETNA PPO
—
05
—
8901618
—
NC
01
—
CC8346
RAILROAD MEDICARE
—
05
—
E01618
—
SC
Enumeration date
11/22/2005
Last updated
06/14/2024
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