Organization
DIAGNOSTIC IMAGING SPECIALISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS FULLER MD (PRESIDENT)
(404) 459-8440
Entity
Organization
Contact information
Practice address
303 PARKWAY DR NE, ATLANTA, GA 30312
(404) 265-4000
Mailing address
PO BOX 591, COLUMBUS, GA 31902-0500
(706) 653-1102
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA0881
RR MEDICARE
—
Enumeration date
11/18/2005
Last updated
01/08/2009
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