Provider Demographics
NPI:1336180637
Name:PIEDMONT CANCER INSTITUTE PC
Entity Type:Organization
Organization Name:PIEDMONT CANCER INSTITUTE PC
Other - Org Name:PEACHTREE HEMATOLOGY ONCOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MININBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-298-3239
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 800
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0922
Mailing Address - Country:US
Mailing Address - Phone:678-298-3239
Mailing Address - Fax:404-477-1162
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0922
Practice Address - Country:US
Practice Address - Phone:404-350-9853
Practice Address - Fax:404-350-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP93Medicare PIN