Basic Information
| Provider Information | |||||||||
| NPI: | 1407035652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGIA CANCER SPECIALISTS I PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704969400 | ||||||||
| FaxNumber: | 7704969495 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 BILL CARRUTH PARKWAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HIRAM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704436019 | ||||||||
| FaxNumber: | 7704436532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | LENZ | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
| AuthorizedOfficialMiddleName: | HAWKE | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7704965555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.