Provider Demographics
NPI:1326312448
Name:EAST ATLANTA HEMATOLOGY & ONCOLOGY LLC
Entity Type:Organization
Organization Name:EAST ATLANTA HEMATOLOGY & ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-385-4426
Mailing Address - Street 1:10157 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3805
Mailing Address - Country:US
Mailing Address - Phone:770-786-0655
Mailing Address - Fax:770-786-6542
Practice Address - Street 1:10157 EAGLE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3805
Practice Address - Country:US
Practice Address - Phone:770-786-0655
Practice Address - Fax:770-786-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20270G6186Medicare PIN