Healthcare Provider Details

I. General information

NPI: 1447542394
Provider Name (Legal Business Name): MEDICAL ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 6700
AUGUSTA GA
30901-5111
US

IV. Provider business mailing address

2822 HILLCREEK DR
AUGUSTA GA
30909-5628
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-4245
  • Fax: 706-722-3648
Mailing address:
  • Phone: 706-774-8326
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE DEASON
Title or Position: DIRECTOR, PHYSICIAN REVENUE CYCLE
Credential:
Phone: 706-774-8326