Provider Demographics
NPI:1497794309
Name:ATLANTA CANCER CARE
Entity Type:Organization
Organization Name:ATLANTA CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOVSSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-851-2300
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-419-1165
Mailing Address - Fax:404-419-1164
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1704
Practice Address - Country:US
Practice Address - Phone:404-851-2300
Practice Address - Fax:404-851-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2445Medicare ID - Type Unspecified