1619392487 NPI number — NSH CANCER INSTITUE PROFESSIONAL SERVICES A, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619392487 NPI number — NSH CANCER INSTITUE PROFESSIONAL SERVICES A, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NSH CANCER INSTITUE PROFESSIONAL SERVICES A, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619392487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 JOHNSON FERRY RD
Provider Second Line Business Mailing Address:
CENTER POINTE 1, SUITE 500
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-419-1140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5670 PEACHTREE DUNWOODY RD
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-851-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF ADMIN SERVICES
Authorized Official Telephone Number:
404-851-6378

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  168354 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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