Provider Demographics
NPI:1902002546
Name:WGIS, INC.
Entity Type:Organization
Organization Name:WGIS, INC.
Other - Org Name:WEST GEORGIA IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ENSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-384-1711
Mailing Address - Street 1:5604 WENDY BAGWELL PKWY
Mailing Address - Street 2:SUITE 911
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7809
Mailing Address - Country:US
Mailing Address - Phone:678-384-1711
Mailing Address - Fax:678-384-1721
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 911
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7809
Practice Address - Country:US
Practice Address - Phone:678-384-1711
Practice Address - Fax:678-384-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3465512471C3402X
GA0223472471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty