Provider Demographics
NPI:1316193626
Name:PHOEBE CANCER CENTER SURGICAL ONCOLOGY
Entity Type:Organization
Organization Name:PHOEBE CANCER CENTER SURGICAL ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:229-312-1000
Mailing Address - Street 1:409 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1915
Mailing Address - Country:US
Mailing Address - Phone:229-312-5080
Mailing Address - Fax:229-312-5085
Practice Address - Street 1:409 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1915
Practice Address - Country:US
Practice Address - Phone:229-312-5080
Practice Address - Fax:229-312-5085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE PUTNEY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0468762086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty