Provider Demographics
NPI:1427093590
Name:OPEN MRI OF CAMDEN LLC
Entity type:Organization
Organization Name:OPEN MRI OF CAMDEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-729-2600
Mailing Address - Street 1:88 LINDSEY LN STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-1656
Mailing Address - Country:US
Mailing Address - Phone:912-729-2600
Mailing Address - Fax:912-729-4122
Practice Address - Street 1:88 LINDSEY LN STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1656
Practice Address - Country:US
Practice Address - Phone:912-729-2600
Practice Address - Fax:912-729-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBNPMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
GA47BBBJKMedicare ID - Type UnspecifiedMEDICARE PROVIDER #