Basic Information
| Provider Information | |||||||||
| NPI: | 1619392487 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NSH CANCER INSTITUE PROFESSIONAL SERVICES A, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ATLANTA CANCER CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FERRY RD | ||||||||
| Address2: | CENTER POINTE 1, SUITE 500 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044191140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5670 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048512300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2014 | ||||||||
| LastUpdateDate: | 03/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF ADMIN SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4048516378 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 168354 | GU | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.