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Organization

DIAGNOSTIC RADIOLOGY ASSOCIATES, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEFFREY SCOTT FORTSON (OPERATIONS MANAGER)
(770) 590-3848
Entity
Organization

Contact information

Practice address
1050 N FLOWOOD DR, SUITE A-4, FLOWOOD, MS 39232-9738
(601) 936-0494
Mailing address
PO BOX 4710, JACKSON, MS 39296-4710
(601) 936-0494

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09011383
MS
01
CL2516
RR MEDICARE
MS
Enumeration date
07/28/2006
Last updated
02/26/2014
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