Healthcare Provider Details

I. General information

NPI: 1760849095
Provider Name (Legal Business Name): RADIATION ONCOLOGY OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2016
Last Update Date: 01/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARKET PLACE BLVD
CARTERSVILLE GA
30121-8718
US

IV. Provider business mailing address

PO BOX 88687
DUNWOODY GA
30356-8687
US

V. Phone/Fax

Practice location:
  • Phone: 678-721-5567
  • Fax: 404-759-2167
Mailing address:
  • Phone: 770-378-2449
  • Fax: 404-759-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number50316
License Number StateGA

VIII. Authorized Official

Name: DR. MARK S QUINN
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 678-491-4338