MEDICARE: MEDICAL ONCOLOGY ASSOCIATES OF AUGUSTA, 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	174400000X	Specialist	16487	GA
2	174400000X	Specialist	46944	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538144480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ONCOLOGY ASSOCIATES OF AUGUSTA, PC

Provider Business Mailing Address
First Line	:	1348 WALTON WAY
Second Line	:	SUITE 6700
City	:	AUGUSTA
State	:	GA
Zip	:	30901-5104
Country	:	US
Telephone Number	:	706-722-4245
Fax Number	:	706-722-6652

Provider Business Practice Location Address
First Line	:	1348 WALTON WAY
Second Line	:	SUITE 6700
City	:	AUGUSTA
State	:	GA
Zip	:	30901-5104
Country	:	US
Telephone Number	:	706-722-4245
Fax Number	:	706-722-6652

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MRS. GLENDA K HALL
Credential	:
Telephone Number	:	706-722-4245

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	08/22/2020

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