Organization Name: | AIC OF DAWSONVILLE, LLC |
NPI Number: | 1144536996 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LATONYA GREENE (CEO) |
Mailing Address: | 91 Nordson Overlook Suite 102 Dawsonville |
State: | GA US |
Postal Code: | 305340990 |
Phone Number: | 8889425272 |
Fax Number: | 6783027215 |
NPI Enumeration Date: | 08/30/2010 |
NPI Last Update Date: | 08/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |