Healthcare Provider Details

I. General information

NPI: 1053591966
Provider Name (Legal Business Name): COLUMBUS RADIATION ONCOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WARM SPRINGS RD STE B
COLUMBUS GA
31904-7954
US

IV. Provider business mailing address

2121 WARM SPRINGS RD STE B
COLUMBUS GA
31904-7954
US

V. Phone/Fax

Practice location:
  • Phone: 706-660-8121
  • Fax: 706-323-4205
Mailing address:
  • Phone: 706-660-8121
  • Fax: 706-323-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number18964
License Number StateGA

VIII. Authorized Official

Name: MRS. AMY MCCOY
Title or Position: BILLING REPRESENTATIVE
Credential:
Phone: 706-660-8121