Organization
DALTON OUTPATIENT CENTER DAL DIAGNOSTIC ASSOC LP
Active
Other names
Dalton Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN CLAYTON CHURCH MD (RADIOLOGIST GENERAL PARTNER)
(706) 278-9729
Entity
Organization
Contact information
Practice address
1502 NORTH THORNTON AVE, DALTON, GA 30720
(706) 278-9729
(706) 226-9378
Mailing address
PO BOX 1207, DALTON, GA 30722-1207
(706) 278-9729
(706) 226-9378
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00248245F
—
GA
01
—
CM5117
RAILROAD MEDICARE
GA
Enumeration date
10/05/2006
Last updated
08/01/2007
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