Provider Demographics
NPI:1548457062
Name:GEORGIA ULTRASOUND, L.L.C.
Entity type:Organization
Organization Name:GEORGIA ULTRASOUND, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-932-8599
Mailing Address - Street 1:3620 MCGINNIS PARK DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7136
Mailing Address - Country:US
Mailing Address - Phone:770-932-8599
Mailing Address - Fax:678-730-1013
Practice Address - Street 1:3620 MCGINNIS PARK DR
Practice Address - Street 2:SUITE #1
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7136
Practice Address - Country:US
Practice Address - Phone:770-932-8599
Practice Address - Fax:678-730-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA031432261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA470001893OtherRAILROAD RETIREMENT
GA47BBBGVMedicare PIN
GAE71966Medicare UPIN