Provider Demographics
NPI:1518701515
Name:INNOVATIVE TELERADIOLOGY INC
Entity type:Organization
Organization Name:INNOVATIVE TELERADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOWES
Authorized Official - Suffix:
Authorized Official - Credentials:CRA
Authorized Official - Phone:404-803-8380
Mailing Address - Street 1:1176 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3900
Mailing Address - Country:US
Mailing Address - Phone:404-803-8380
Mailing Address - Fax:
Practice Address - Street 1:1176 MICHAEL LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3900
Practice Address - Country:US
Practice Address - Phone:404-803-8380
Practice Address - Fax:404-745-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology