Provider Demographics
NPI:1710365630
Name:GRENADA HEMATOLOGY ONCOLOGY LLC
Entity Type:Organization
Organization Name:GRENADA HEMATOLOGY ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FURHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-307-7424
Mailing Address - Street 1:1300 SUNSET DR STE F
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4083
Mailing Address - Country:US
Mailing Address - Phone:662-307-7424
Mailing Address - Fax:
Practice Address - Street 1:1300 SUNSET DR STE F
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4083
Practice Address - Country:US
Practice Address - Phone:662-307-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15052207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty