Provider Demographics
NPI:1225746894
Name:BIOCARE ONCOLOGY AND THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:BIOCARE ONCOLOGY AND THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:IWUDIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:470-377-6400
Mailing Address - Street 1:371 E PACES FERRY RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2372
Mailing Address - Country:US
Mailing Address - Phone:470-377-6400
Mailing Address - Fax:
Practice Address - Street 1:371 E PACES FERRY RD NE STE 640
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2372
Practice Address - Country:US
Practice Address - Phone:508-315-2769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty