Provider Demographics
NPI:1710196589
Name:SJC ONCOLOGY SERVICES - GEORGIA, LLC
Entity Type:Organization
Organization Name:SJC ONCOLOGY SERVICES - GEORGIA, LLC
Other - Org Name:F & G ASSOCIATES, LP D/B/A SAVANNAH ONCOLOGY CENTER LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-6162
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT 1622
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1622
Mailing Address - Country:US
Mailing Address - Phone:912-352-1700
Mailing Address - Fax:912-352-1066
Practice Address - Street 1:225 CANDLER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6023
Practice Address - Country:US
Practice Address - Phone:912-352-1700
Practice Address - Fax:912-354-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207VX0201X, 2085R0001X, 261QX0200X
GA616842086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300026248AMedicaid
GACI8039OtherRAILROAD MEDICARE
GA050316OtherLICENSE - M QUINN MD
GA300026248AMedicaid
GA61684OtherLICENSE - H ZAREN MD
GACI8039OtherRAILROAD MEDICARE
GA61684OtherLICENSE - H ZAREN MD