Provider Demographics
NPI:1265640247
Name:GEORGIA CANCER SPECIALISTS I PC
Entity Type:Organization
Organization Name:GEORGIA CANCER SPECIALISTS I PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:HAWKE
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-496-5555
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:125 KING AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6734
Practice Address - Country:US
Practice Address - Phone:706-369-4478
Practice Address - Fax:706-353-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2415Medicare PIN
GA1014360036Medicare NSC
GACA9328Medicare PIN