Organization Name: | CANTON SPECIALTY IMAGING, LLC |
NPI Number: | 1457640831 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRADLEY R PETERS (MEMBER/MEDICAL DIRECTOR) |
Mailing Address: | 200 Oakside Ln Suite A Canton |
State: | GA US |
Postal Code: | 301146416 |
Phone Number: | 7704791945 |
Fax Number: | 7704791948 |
NPI Enumeration Date: | 04/06/2011 |
NPI Last Update Date: | 04/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 051890 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |