Healthcare Provider Details

I. General information

NPI: 1538144480
Provider Name (Legal Business Name): MEDICAL ONCOLOGY ASSOCIATES OF AUGUSTA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY SUITE 6700
AUGUSTA GA
30901-5104
US

IV. Provider business mailing address

1348 WALTON WAY SUITE 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 TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16487
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number46944
License Number StateGA

VIII. Authorized Official

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