Provider Demographics
NPI:1760849095
Name:RADIATION ONCOLOGY OF GEORGIA LLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-491-4338
Mailing Address - Street 1:PO BOX 88687
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30356-8687
Mailing Address - Country:US
Mailing Address - Phone:770-378-2449
Mailing Address - Fax:404-759-2167
Practice Address - Street 1:100 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8718
Practice Address - Country:US
Practice Address - Phone:678-721-5567
Practice Address - Fax:404-759-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA503162085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKG29917Medicare PIN