Healthcare Provider Details

I. General information

NPI: 1073584207
Provider Name (Legal Business Name): SOUTHEASTERN GYNECOLOGIC ONCOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD NE SUITE 900
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

980 JOHNSON FERRY RD NE SUITE 900
ATLANTA GA
30342-1626
US

V. Phone/Fax

Practice location:
  • Phone: 678-420-4100
  • Fax: 678-420-4120
Mailing address:
  • Phone: 678-420-4100
  • Fax: 678-420-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD FEUER
Title or Position: DOCTOR/PARTNER
Credential: M.D.
Phone: 678-420-4100