Provider Demographics
NPI:1700026606
Name:SATILLA CANCER TREATMENT CENTERS, LLC
Entity Type:Organization
Organization Name:SATILLA CANCER TREATMENT CENTERS, LLC
Other - Org Name:CUREPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLICOTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-2255
Mailing Address - Street 1:1400 PETERSON AVE N
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2832
Mailing Address - Country:US
Mailing Address - Phone:912-383-0815
Mailing Address - Fax:912-383-0826
Practice Address - Street 1:1451 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3531
Practice Address - Country:US
Practice Address - Phone:912-283-3087
Practice Address - Fax:912-283-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055248207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADQ2362OtherRR MCR
GA300027669FMedicaid
GA202G708768OtherMEDICARE PTAN
GA11D1096832OtherCLIA