Basic Information
| Provider Information | |||||||||
| NPI: | 1831102268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND RADIOLOGY ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6070 | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664579896 | ||||||||
| FaxNumber: | 7062662283 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 HIGHWAY 70 E | ||||||||
| Address2: | |||||||||
| City: | DICKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664579896 | ||||||||
| FaxNumber: | 7062262283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | HAWKINS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT GROUP | ||||||||
| AuthorizedOfficialTelephone: | 8664579896 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3721245 | 05 | TN | MEDICAID | CH7179 | 01 | TN | RAILROAD MEDICARE | OTHER |