Provider Demographics
NPI:1538768296
Name:GA DIAGNOSTIC PROVIDERS LLC
Entity type:Organization
Organization Name:GA DIAGNOSTIC PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:478-972-8865
Mailing Address - Street 1:5400 RIVERSIDE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-0818
Mailing Address - Country:US
Mailing Address - Phone:478-972-8865
Mailing Address - Fax:855-428-4597
Practice Address - Street 1:5400 RIVERSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0818
Practice Address - Country:US
Practice Address - Phone:478-787-0059
Practice Address - Fax:855-428-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No293D00000XLaboratoriesPhysiological Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies