Provider Demographics
NPI:1730354465
Name:SIVAD IMAGING LLC
Entity type:Organization
Organization Name:SIVAD IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RCS
Authorized Official - Phone:706-863-2872
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-1250
Mailing Address - Country:US
Mailing Address - Phone:706-863-2872
Mailing Address - Fax:706-863-2872
Practice Address - Street 1:4851 ORCHARD HILL DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-6324
Practice Address - Country:US
Practice Address - Phone:706-863-2872
Practice Address - Fax:706-863-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15623246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty