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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