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

General Provider Information

NPI Number	:	1508871468
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	:	6002 PROFESSIONAL PARKWAY
Second Line	:	SUITE 200
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5600
Country	:	US
Telephone Number	:	770-942-0457
Fax Number	:	770-942-7699

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/20/2008

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