Organization
COASTAL DIAGNOSTIC IMAGING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE VILLA (COO)
(770) 300-0101
Entity
Organization
Contact information
Practice address
3606 HENDERSON DR, JACKSONVILLE, NC 28546-5217
(910) 937-7226
Mailing address
4300 N POINT PKWY, CREDENTIALING DEPT, ALPHARETTA, GA 30022-4102
(770) 300-0101
(770) 300-0429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/26/2006
Last updated
08/22/2020
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