1598893471 NPI number — GREATER ATLANTA RADIATION ONCOLOGY CONSULTANTS, LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598893471 NPI number — GREATER ATLANTA RADIATION ONCOLOGY CONSULTANTS, LLC

Employer Identification Number (EIN):

Provider Organization Name:

GREATER ATLANTA RADIATION ONCOLOGY CONSULTANTS, LLC

Provider Last Name:

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Provider Middle Name:

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NPI Number:

1598893471

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/21/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

179 WORTHINGTON WAY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

JONESBORO

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30236-5588

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

404-704-5887

Provider Business Mailing Address Fax Number:

678-565-0606

Provider First Line Business Practice Location Address:

2675 N DECATUR RD

Provider Second Line Business Practice Location Address:

SUITE G03

Provider Business Practice Location Address City Name:

DECATUR

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30033-6131

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

404-501-6925

Provider Business Practice Location Address Fax Number:

404-501-6930

Provider Enumeration Date:

03/01/2007

Authorized Official Last Name:

COLE

Authorized Official First Name:

TONYA

Authorized Official Middle Name:

ECHOLS

Authorized Official Title or Position:

MANAGING MEMBER

Authorized Official Telephone Number:

404-501-6925

• Taxonomy code: 2085R0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 30 00519 . This is a "UHC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 7488088 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 000835788R , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 172201200452 . This is a "HUMANA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: P00231025 . This is a "RR MEDICARE PALMETTO GBA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 117237 . This is a "PEACHSTATE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 12557 . This is a "1ST MEDICAL NETWORK" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 287785207 . This is a "CHAMPUS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 36 00519 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 10068321 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 782373(EMC) . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".