Provider Demographics
NPI:1386669240
Name:LOW COUNTRY CANCER CARE
Entity Type:Organization
Organization Name:LOW COUNTRY CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOERA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RENDON DE VALLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-692-2000
Mailing Address - Street 1:225 CANDLER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6023
Mailing Address - Country:US
Mailing Address - Phone:912-692-2000
Mailing Address - Fax:912-692-2100
Practice Address - Street 1:225 CANDLER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6023
Practice Address - Country:US
Practice Address - Phone:912-692-2000
Practice Address - Fax:912-692-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000489233EMedicaid
GAE73835Medicare UPIN