Healthcare Provider Details

I. General information

NPI: 1053638528
Provider Name (Legal Business Name): MONROEVILLE RADIATION ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOSPITAL DR
JACKSON AL
36545-2459
US

IV. Provider business mailing address

3330 PRESTON RIDGE RD 300
ALPHARETTA GA
30005-4508
US

V. Phone/Fax

Practice location:
  • Phone: 251-246-1159
  • Fax: 770-512-8937
Mailing address:
  • Phone: 770-255-7430
  • Fax: 770-512-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM C HIXSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 251-626-1755