Organization
PET IMAGING CENTER OF GWINNETT LLC
Active
Parent organization
TRIDENT MEDICAL IMAGING
Other names
Trident Medical Imaging- Gwinnett
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRIDENT MEDICAL IMAGING
Authorized official
CRYSTAL GATES (DIRECTOR OF PATIENT ACCOUNTS)
(770) 692-1387
Entity
Organization
Contact information
Practice address
555 OLD NORCROSS RD, 115, LAWRENCEVILLE, GA 30046-8716
(770) 277-0501
(770) 277-4324
Mailing address
1275 HIGHWAY 54 W, 103, FAYETTEVILLE, GA 30214-4549
(770) 692-1387
(770) 692-2373
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
09/21/2010
Last updated
09/21/2010
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