Basic Information
| Provider Information | |||||||||
| NPI: | 1679761282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH GEORGIA CANCER CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36 | ||||||||
| Address2: | |||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307030036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066254285 | ||||||||
| FaxNumber: | 7066253905 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WILLOWBROOK WAY SE | ||||||||
| Address2: | |||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307011404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066254285 | ||||||||
| FaxNumber: | 7066253905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | ERIC | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7066254285 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QX0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 760447935A | 05 | GA | MEDICAID |