| Organization Name: | DESOTO DIAGNOSTIC IMAGING, LLC |
| NPI Number: | 1083777882 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN M GRAVES (PRESIDENT) |
| Mailing Address: | 9085 Sandidge Center Cove Suite 100 Olive Branch |
| State: | MS US |
| Postal Code: | 386543575 |
| Phone Number: | 6625361000 |
| Fax Number: | 6628938824 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 11/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3401X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Computed Tomography |
| Taxonomy Definition: | |