Provider Demographics
NPI:1073983136
Name:GEORGIA ONCOLOGISTS ASSISTANCE
Entity Type:Organization
Organization Name:GEORGIA ONCOLOGISTS ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-699-7347
Mailing Address - Street 1:5885 CUMMING HWY
Mailing Address - Street 2:SUITE 108 BOX 256
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5765
Mailing Address - Country:US
Mailing Address - Phone:678-820-9001
Mailing Address - Fax:
Practice Address - Street 1:5885 CUMMING HWY
Practice Address - Street 2:SUITE 108 BOX 256
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5765
Practice Address - Country:US
Practice Address - Phone:678-820-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1421363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty