Healthcare Provider Details

I. General information

NPI: 1477597656
Provider Name (Legal Business Name): BRUCE WARREN HERSHATTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF RADIATION ONCOLOGY/EMORY UNIVERSITY 1320 CLIFTON ROAD
ATLANTA GA
30322
US

IV. Provider business mailing address

4400 MOUNT PARAN PKWY
ATLANTA GA
30327
US

V. Phone/Fax

Practice location:
  • Phone: 404-372-9456
  • Fax: 404-327-4996
Mailing address:
  • Phone: 404-321-6111
  • Fax: 404-327-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number029465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: