Provider Demographics
NPI:1972764298
Name:SUBURBAN HEMATOLOGY ONCOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:SUBURBAN HEMATOLOGY ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-533-1555
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:770-623-6433
Mailing Address - Fax:
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:770-623-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH5181OtherMCARE RR GROUP#
GRP3891OtherMCARE GROUP#
P00024271Medicare PIN
GRP3891OtherMCARE GROUP#
900003457Medicare PIN
CH5181OtherMCARE RR GROUP#
4188940001Medicare NSC
900003455Medicare PIN
4188940003Medicare PIN