Provider Demographics
NPI:1811075252
Name:GEORGIA CANCER SPECIALISTS I PC
Entity type:Organization
Organization Name:GEORGIA CANCER SPECIALISTS I PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-495-3396
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:246 ODELL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4880
Practice Address - Country:US
Practice Address - Phone:770-228-2324
Practice Address - Fax:770-228-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2415Medicare PIN
GA1014360034Medicare NSC
GACA9328Medicare PIN