Provider Demographics
NPI:1154453058
Name:EAST GEORGIA CANCER CENTER
Entity Type:Organization
Organization Name:EAST GEORGIA CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHUSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-871-8000
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0397
Mailing Address - Country:US
Mailing Address - Phone:912-871-8000
Mailing Address - Fax:912-871-3030
Practice Address - Street 1:1601 FAIR RD
Practice Address - Street 2:#900
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1698
Practice Address - Country:US
Practice Address - Phone:912-871-8000
Practice Address - Fax:912-871-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051780207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83BBBSGMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAGRP 4630Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER