Healthcare Provider Details

I. General information

NPI: 1437391190
Provider Name (Legal Business Name): THE GEORGIA CENTER FOR TOTAL CANCER CARE AT PRESTON RIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PRESTON RIDGE 100
ALPHARETTA GA
30005-3330
US

IV. Provider business mailing address

3330 PRESTON RIDGE DRIVE
ALPHARETTA GA
30005-3330
US

V. Phone/Fax

Practice location:
  • Phone: 770-255-7500
  • Fax: 770-255-7501
Mailing address:
  • Phone: 770-255-7500
  • Fax: 770-255-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DALE LYNN MCCORD
Title or Position: CEO
Credential: MD
Phone: 770-255-7402