Healthcare Provider Details

I. General information

NPI: 1437164159
Provider Name (Legal Business Name): GEORGIA CANCER SPECIALISTS I PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DRIVE SUITE 102
AUSTELL GA
30106-6810
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-3233
  • Fax: 770-944-1537
Mailing address:
  • Phone: 770-495-3396
  • Fax: 770-495-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. WENDY HAWKE
Title or Position: C.O.O.
Credential: M.D.
Phone: 770-621-8656