Provider Demographics
NPI:1457553968
Name:GAINESVILLE IMAGING ASSOCIATES PC
Entity type:Organization
Organization Name:GAINESVILLE IMAGING ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-532-9936
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-2438
Mailing Address - Country:US
Mailing Address - Phone:770-532-9936
Mailing Address - Fax:770-534-9877
Practice Address - Street 1:1250 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE. 500
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3871
Practice Address - Country:US
Practice Address - Phone:770-532-9936
Practice Address - Fax:770-534-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0331422085B0100X, 2085D0003X, 2085H0002X, 2085N0700X, 2085N0904X, 2085R0203X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7496Medicare PIN