SOUTHEAST GEORGIA OPEN MRI LLC (NPI# 1255438974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255438974 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST GEORGIA OPEN MRI LLC |
| Practice Address |
1103 Fountain Lake Drive Brunswick GA 31525 |
| Practice Telephone | 9122676736 |
| Practice Fax Number | 9122621922 |
| Mailing Telephone | 9122676736 |
| Mailing Fax Number | 9122621922 |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2012-01-27 |
| Authorized Official Name | MS. CAROLINE HARRIS (ACCOUNT DIRECTOR) |
| Authorized Official Telephone | 9122676736 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BILLING PROVIDER NUMBER | 1942294848 | 01 | |
| GA | 00469169G | 05 |
| Street Address |
1103 FOUNTAIN LAKE DRIVE |
| City | BRUNSWICK |
| State | GA |
| Zip Code | 31525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063905990 | Jonathon Wesley Capps | Physician Assistant | 1111 Glynco Pkwy Bldg 1, Ste 10, Brunswick, GA 31525 | 2018-06-14 |
| 1366993628 | Hands Down Muscle Restoration, Inc | Homeopath | 1212 Chapel Crossing Road, Brunswick, GA 31525 | 2016-10-20 |
| 1619424173 | Jebediah S Christy Dds - Brunswick Pllc | Dentist | 11455 Canal Crossing, Brunswick, GA 31525 | 2016-09-01 |
| 1831545508 | Heller Family Medicine, LLC | General Practice | 208 Scranton Connector Ste 120, Brunswick, GA 31525 | 2016-05-11 |
| 1437525391 | Natisha Danielle Hill | Occupational Therapy Assistant | 138 Wingefield Commons Drive, Brunswick, GA 31525 | 2015-08-14 |
| 1811269632 | Solar Family Practice | Family Medicine | 122 Scranton Connector, Suite 112, Brunswick, GA 31525 | 2012-02-09 |
| 1700187895 | Chetan Patel | Pharmacist | 12 Woodfall Ct, Brunswick, GA 31525 | 2010-11-05 |
| 1194914275 | Dialysis of Golden Isles, LLC | Clinic/Center | 475 Gateway Center Blvd, Brunswick, GA 31525 | 2007-10-15 |
| 1902939325 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 111 Frazier Street, Brunswick, GA 31525 | 2007-03-14 |
| 1609909498 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 115 Frazier Road, Brunswick, GA 31525 | 2007-03-13 |
| Find all providers in zip 31525 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982642732 | Mark M Eule | Radiology | 123 Medical Center Drive, Brunswick, ME 04011-2652 | 2006-06-03 |
| 1922089713 | Northwest Diagnostic Imaging, Inc | Radiology | 1111 Glynco Pkwy, Brunswick, GA 31525-7921 | 2005-11-08 |
| 1912997859 | Terry L Reynolds | Radiology | 2415 Parkwood Drive, Brunswick, GA 31520-4722 | 2005-10-23 |
| 1396731733 | Donald H Manning | Radiology | 403 Eh Court, Brunswick, GA 31520-4743 | 2005-09-21 |
| 1942294087 | Radiology Consultants PC | Radiology | 2415 Parkwood Dr, Brunswick, GA 31520-4722 | 2005-09-05 |
| 1013911841 | Philip S Crichton | Radiology | 123 Medical Center Dr, Brunswick, ME 04011-2652 | 2005-06-09 |
| 1164830139 | Radiology Consultants of Maine, LLC | Radiology | 123 Medical Center Dr, Brunswick, ME 04011-2652 | 2014-07-23 |
| 1720491509 | Michael Talarico | Radiology | 123 Medical Center Dr, Brunswick, ME 04011-2652 | 2014-06-09 |
| 1992144976 | Thomas D Cesca | Radiology | 123 Medical Center Dr, Brunswick, ME 04011-2652 | 2013-06-23 |
| 1396802120 | Barbara A Luke | Radiology | 123 Medical Center Dr, Brunswick, ME 04011-2652 | 2007-01-02 |
| Find all providers in BRUNSWICK | ||||
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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.