Provider Demographics
NPI:1932478849
Name:MEDICAL ONCOLOGY CONSULTANTS OF ATLANTA
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY CONSULTANTS OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-610-1421
Mailing Address - Street 1:925B PEACHTREE ST NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3918
Mailing Address - Country:US
Mailing Address - Phone:404-501-6180
Mailing Address - Fax:404-501-6190
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-501-6180
Practice Address - Fax:404-501-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty