Provider Demographics
NPI:1437550811
Name:SJC ONCOLOGY SERVICES-GEORGIA, LLC
Entity Type:Organization
Organization Name:SJC ONCOLOGY SERVICES-GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GYN ONCOLOGY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-819-5771
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6015
Mailing Address - Country:US
Mailing Address - Phone:912-819-5771
Mailing Address - Fax:912-819-5772
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-819-5771
Practice Address - Fax:912-819-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176789282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital