Basic Information
| Provider Information | |||||||||
| NPI: | 1124255286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH AMERICAN IMAGING OF BUFORD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2598 | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301569110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707792176 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3425 BUFORD DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305198785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787656060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2009 | ||||||||
| LastUpdateDate: | 08/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | RUDE | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7707792167 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.