Provider Demographics
NPI:1083107999
Name:GEORGIA PROTONCARE CENTER, INC.
Entity Type:Organization
Organization Name:GEORGIA PROTONCARE CENTER, INC.
Other - Org Name:EMORY PROTON THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-3977
Mailing Address - Street 1:615 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2309
Mailing Address - Country:US
Mailing Address - Phone:770-217-7565
Mailing Address - Fax:
Practice Address - Street 1:615 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2309
Practice Address - Country:US
Practice Address - Phone:770-217-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261Q00000X
261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation