Provider Demographics
NPI:1336477934
Name:SATILLA CANCER TREATMENT CENTERS, LLC
Entity Type:Organization
Organization Name:SATILLA CANCER TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLICOTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-2255
Mailing Address - Street 1:2406 BELLEVUE AVENUE
Mailing Address - Street 2:#7
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0000
Mailing Address - Country:US
Mailing Address - Phone:478-272-2255
Mailing Address - Fax:478-275-9134
Practice Address - Street 1:2406 BELLEVUE AVENUE
Practice Address - Street 2:#7
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-0000
Practice Address - Country:US
Practice Address - Phone:478-272-2255
Practice Address - Fax:478-275-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty