Healthcare Provider Details

I. General information

NPI: 1114931946
Provider Name (Legal Business Name): MEDICAL ONCOLOGY ASSOCIASTES OF AUGUSTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 6700
AUGUSTA GA
30901-5104
US

IV. Provider business mailing address

1348 WALTON WAY STE 6700
AUGUSTA GA
30901-5104
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-4245
  • Fax: 706-722-6652
Mailing address:
  • Phone: 706-722-4245
  • Fax: 706-722-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number026400
License Number StateGA

VIII. Authorized Official

Name: MRS. GLENDA HALL
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 706-722-4245