Provider Demographics
NPI:1104033463
Name:SATILLA CANCER TREATMENT CENTERS, LLC
Entity Type:Organization
Organization Name:SATILLA CANCER TREATMENT CENTERS, LLC
Other - Org Name:CUREPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLICOTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-2255
Mailing Address - Street 1:2406 BELLEVUE RD
Mailing Address - Street 2:#7
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2842
Mailing Address - Country:US
Mailing Address - Phone:478-272-2255
Mailing Address - Fax:478-275-9134
Practice Address - Street 1:2406 BELLEVUE RD
Practice Address - Street 2:#7
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2842
Practice Address - Country:US
Practice Address - Phone:478-272-2255
Practice Address - Fax:478-275-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300038888AMedicaid
GA202G708768OtherMEDICARE PTAN
GADQ2362OtherRR MCR
GA11D1096814OtherCLIA