Basic Information
| Provider Information | |||||||||
| NPI: | 1265451215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BATTLEFIELD IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 GUNBARREL RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236482395 | ||||||||
| FaxNumber: | 4236487542 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 BATTLEFIELD PKWY | ||||||||
| Address2: | STE 100 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307365166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068060170 | ||||||||
| FaxNumber: | 7068060200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7068060170 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 757199790F | 05 | GA | MEDICAID | 52853264-001 | 01 | GA | BCBS OF GA | OTHER | 4072958 | 01 | TN | BCS OF TN | OTHER |