Organization
OPEN MRI OF LAGRANGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT RANDOLPH COMERFORD MD (MEDICAL DIRECTOR)
(706) 882-1399
Entity
Organization
Contact information
Practice address
1805 VERNON RD, SUITE D, LAGRANGE, GA 30240-4041
(706) 882-1399
(706) 882-1421
Mailing address
1805 VERNON RD, SUITE D, LAGRANGE, GA 30240-4041
(706) 882-1399
(706) 882-1421
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00599189B
—
GA
Enumeration date
02/23/2007
Last updated
08/22/2020
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