Provider Demographics
NPI:1568712594
Name:NSH CANCER INSTITUTE PROFESSIONAL SERVICES A,LLC
Entity Type:Organization
Organization Name:NSH CANCER INSTITUTE PROFESSIONAL SERVICES A,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMIN SERVICES AND CCO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-851-6378
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD NE STE 1100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4795
Practice Address - Country:US
Practice Address - Phone:404-851-6378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSIDE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-18
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID