Healthcare Provider Details

I. General information

NPI: 1114235975
Provider Name (Legal Business Name): RADIOTHERAPY CANCER CENTERS LLC - CHEROKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OAKSIDE DR
CANTON GA
30114-2430
US

IV. Provider business mailing address

53 PERIMETER CTR E SUITE 500
ATLANTA GA
30346-2294
US

V. Phone/Fax

Practice location:
  • Phone: 770-479-1761
  • Fax:
Mailing address:
  • Phone: 770-682-2099
  • Fax: 866-281-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number2010PROFS-0025
License Number StateGA

VIII. Authorized Official

Name: VICTORIA BECK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 770-682-2099