Provider Demographics
NPI:1457573073
Name:CANCER CARE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:CANCER CARE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-501-6925
Mailing Address - Street 1:PO BOX 98446
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359
Mailing Address - Country:US
Mailing Address - Phone:404-423-8881
Mailing Address - Fax:404-321-0223
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE G03
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-501-6925
Practice Address - Fax:404-501-6930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP8109OtherMEDICARE GROUP NUMBER
GAH17641Medicare UPIN