Provider Demographics
NPI:1669663365
Name:CENTER OF HOPE FOR CANCERS AND BLOOD DISORDERS
Entity Type:Organization
Organization Name:CENTER OF HOPE FOR CANCERS AND BLOOD DISORDERS
Other - Org Name:CENTER OF HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ONYEGBULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-629-2337
Mailing Address - Street 1:P.O. BOX 1710
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-629-2337
Mailing Address - Fax:770-629-5194
Practice Address - Street 1:7444 HANNOVER PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-629-2337
Practice Address - Fax:770-629-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA696378996BMedicaid
GAGRP7305Medicare PIN
GA696378996BMedicaid