Organization
IMAGING ASSOCIATES OF CANTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY ROBERT PETERS M.D. (PRESIDENT / MEDICAL DIRECTOR)
(770) 479-1945
Entity
Organization
Contact information
Practice address
200 OAKSIDE LN, SUITE A, CANTON, GA 30114-6415
(770) 479-1945
(770) 479-1948
Mailing address
200 OAKSIDE LN, SUITE A, CANTON, GA 30114-6415
(770) 479-1945
(770) 479-1948
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000964268L
—
GA
01
—
10051310
AMERIGROUP
GA
01
—
129908
PEACHSTATE
GA
01
—
319443
WELLCARE
GA
Enumeration date
05/26/2006
Last updated
04/25/2008
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