1447265020 NPI number — GEORGIA CANCER SPECIALISTS I PC

Table of content: NICOLE NATALIA PAEZ MSW (NPI 1558155499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447265020 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:
1447265020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2009
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:
6335 HOSPITAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-623-8965
Provider Business Practice Location Address Fax Number:
770-623-4108
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKE
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
770-621-8656

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)





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