Provider Demographics
NPI:1689628075
Name:MIDDLE GEORGIA RADIATION PARTNERS, LP
Entity Type:Organization
Organization Name:MIDDLE GEORGIA RADIATION PARTNERS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-350-0126
Mailing Address - Street 1:3330 PRESTON RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4508
Mailing Address - Country:US
Mailing Address - Phone:770-350-0126
Mailing Address - Fax:770-350-6637
Practice Address - Street 1:214 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-892-8585
Practice Address - Fax:478-892-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4795Medicare ID - Type UnspecifiedGROUP