MEDICARE: GEORGIA CANCER SPECIALISTS I PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497761779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA CANCER SPECIALISTS I PC

Provider Business Mailing Address
First Line	:	1835 SAVOY DR
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30341-1072
Country	:	US
Telephone Number	:	770-495-3396
Fax Number	:	770-495-2307

Provider Business Practice Location Address
First Line	:	1505 NORTHSIDE BLVD
Second Line	:	SUITE 4300
City	:	CUMMING
State	:	GA
Zip	:	30041-7623
Country	:	US
Telephone Number	:	770-205-1331
Fax Number	:	770-205-8727

Authorized Official
Title or Position	:	C.O.O.
Name	:	DR. WENDY HAWKE
Credential	:	M.D.
Telephone Number	:	770-621-8656

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/01/2011

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