Organization
SOURCE DIAGNOSTICS OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN A BARRY (COO)
(440) 645-7822
Entity
Organization
Contact information
Practice address
5559 THOMASTON RD, MACON, GA 31220-8120
(478) 405-7015
Mailing address
5275 NAIMAN PKWY, SUITE E, SOLON, OH 44139-1029
(440) 542-1515
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Enumeration date
07/28/2010
Last updated
03/28/2012
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