1013215938 NPI number — GEORGIA CANCER SPECIALISTS I, PC

Table of content: (NPI 1013215938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013215938 NPI number — GEORGIA CANCER SPECIALISTS I, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA CANCER SPECIALISTS I, PC
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:
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:
1013215938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 SAVOY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30341-1072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-495-3396
Provider Business Mailing Address Fax Number:
770-495-2307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3886 PRINCETON LAKES WAY SW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30331-5511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-349-7300
Provider Business Practice Location Address Fax Number:
404-349-7344
Provider Enumeration Date:
03/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LENZ
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
770-496-5555

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GRP2415 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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