Organization
PRI X-RAY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN TRADER (MANAGER)
(770) 932-8599
Entity
Organization
Contact information
Practice address
3620 MCGINNIS PARK DR, SUITE #1, SUWANEE, GA 30024-7136
(770) 932-8599
(770) 614-8048
Mailing address
3620 MCGINNIS PARK DR, SUITE #1, SUWANEE, GA 30024-7136
(770) 932-8599
(770) 614-8048
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00803822A
—
GA
01
—
630001384
RAILROAD MEDICARE
—
Enumeration date
11/15/2005
Last updated
04/27/2011
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