Organization
OPEN MRI OF BRUNSWICK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY K GORDON M.D. (OWNER)
(770) 451-4040
Entity
Organization
Contact information
Practice address
2414 PARKWOOD DR, SUITE 100, BRUNSWICK, GA 31520-4779
(770) 451-4040
(770) 451-3003
Mailing address
2414B PARKWOOD DR, BRUNSWICK, GA 31520-4721
(770) 451-4040
(770) 451-3003
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
031432
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000449765AC
—
GA
01
—
202I300099
MEDICARE PROVIDER
GA
Enumeration date
01/14/2009
Last updated
06/18/2012
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