| NPI | 1902142151 |
|---|---|
| Former Legal Business Name | ATLANTIC IMAGING GROUP-IPA, LLC |
| Entity Type | Organization |
| Authorized Contact | KEVIN M MAHONEY President 770-865-3222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2021-06-22 |