SOURCE DIAGNOSTICS OF GEORGIA, LLC (NPI# 1700190105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700190105 |
| Entity Type | Organization |
| Organization Name | SOURCE DIAGNOSTICS OF GEORGIA, LLC |
| Practice Address |
5559 Thomaston Rd Macon GA 31220-8120 |
| Mailing Address |
5275 Naiman Pkwy Suite E Solon OH 44139-1029 |
| Practice Telephone | 4784057015 |
| Mailing Telephone | 4405421515 |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2012-03-28 |
| Authorized Official Name | MS. KATHLEEN A BARRY (COO) |
| Authorized Official Telephone | 4406457822 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477819183 | Source Diagnostics of Georgia, LLC | Clinic/Center | 5559 Thomaston Rd, Macon, GA 31220-8120 | 2012-04-06 |
| Street Address |
5559 THOMASTON RD |
| City | MACON |
| State | GA |
| Zip Code | 31220-8120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477819183 | Source Diagnostics of Georgia, LLC | Clinic/Center | 5559 Thomaston Rd, Macon, GA 31220-8120 | 2012-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174864979 | Kenwana Michelle Vanderbilt | Psychologist | Macon Outpatient Clinic- 5398 Thomaston Rd., Suite B, Macon, GA 31220 | 2013-03-05 |
| 1720287345 | Lynda Jean Logan | Registered Nurse | 5398 Thomaston Road Suite B, Macon, GA 31220 | 2007-07-13 |
| 1811085434 | Timmi Hagan | Dentist | 4196 Cavalier Dr, Macon, GA 31220 | 2006-10-10 |
| 1154375756 | Lois Jane Macdonnell | Psychiatry & Neurology | 5566 Thomaston Rd, Macon, GA 31220 | 2006-05-19 |
| 1508129438 | Venyette Thomas | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220 | 2012-06-15 |
| 1710260575 | Vijay H Patel | Pharmacist | 1280 Gray Hwy, Macon, GA 31220 | 2011-09-27 |
| 1023065638 | Dublin Vamc | Clinic/Center | 5566 Thomaston Rd, Macon, GA 31220 | 2006-05-28 |
| 1386847614 | Georgia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2007-06-06 |
| 1588128581 | Samuel Scott Collier | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2019-01-24 |
| 1841652310 | Christopher Hayes | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2016-03-24 |
| Find all providers in zip 31220 | ||||
| Taxonomy Code | 335V00000X |
| Grouping | Suppliers |
| Classification | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144609876 | Optimus Diagnostics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 252 Holt Ave, Macon, GA 31201-1227 | 2015-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982185237 | Guillaume J Pinguet | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 4760 Austell Rd Ste A, Austell, GA 30106-2007 | 2018-08-24 |
| 1790288587 | Acc3 International, Inc. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3340 Peachtree Rd Ne Ste 2025, Atlanta, GA 30326-1084 | 2018-03-17 |
| 1053858761 | Mobile Medical Imaging of Coastal Georgia, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 5906 Hwy 21 S, Unit 4, Springfield, GA 31326-5505 | 2017-01-20 |
| 1013392315 | Schryver Medical Sales and Marketing, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3500 Lenox Rd Ne, Suite 1500, Atlanta, GA 30326-4228 | 2015-07-28 |
| 1215316435 | Jlm X-ray LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1015 Canton Street, Roswell, GA 30075 | 2015-05-20 |
| 1023410842 | The Pink Ribbon Mammography and Diagnostic Radiology Services LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 33 Darbys Ave, Hiram, GA 30141-4143 | 2014-09-24 |
| 1477826493 | Mobile Physician Services, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1171 Laurel Pointe, Bogart, GA 30622-2859 | 2012-02-22 |
| 1306140215 | Avery Partners, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1455 Old Alabama Rd Ste 160, Roswell, GA 30076-2167 | 2011-01-06 |
| 1164670667 | Home Care Imaging | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 187 Sherwood Forest Dr, Douglasville, GA 30134-5808 | 2008-09-09 |
| 1588708119 | Sinorien Healthcare Services | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1462 Montreal Rd Ste 112, Tucker, GA 30084-6904 | 2007-02-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.