Organization
OPEN MRI OF DOUGLAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLINE HARRIS (ACCOUNT DIRECTOR)
(912) 267-6736
Entity
Organization
Contact information
Practice address
1315 OCILLA ROAD, DOUGLAS, GA 31533
(912) 393-1144
(912) 393-1124
Mailing address
1103 FOUNTAIN LAKE DR, BRUNSWICK, GA 31525-3039
(912) 267-6736
(912) 262-1922
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00469169H
—
GA
01
—
1942294848
RADIOLOGIST
GA
Enumeration date
10/17/2006
Last updated
01/27/2012
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