| Organization Name: | VIDALIA OPEN MRI, LLC |
| NPI Number: | 1164599353 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRANK HARRELSON (OFFICE MANAGER) |
| Mailing Address: | 3165 E 1st St Vidalia |
| State: | GA US |
| Postal Code: | 304748830 |
| Phone Number: | 8004741077 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2006 |
| NPI Last Update Date: | 08/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471M1202X |
| License Number: | 025199 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Magnetic Resonance Imaging |
| Taxonomy Definition: | |