Healthcare Provider Details
I. General information
NPI: 1457583452
Provider Name (Legal Business Name): COLUMBUS CANCER TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2121 WARM SPRINGS RD SUITE B
COLUMBUS GA
31904-7955
US
IV. Provider business mailing address
104 WOODMONT BLVD 500
NASHVILLE TN
37205-2245
US
V. Phone/Fax
- Phone: 706-660-8121
- Fax: 706-323-4205
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QX0203X |
| Taxonomy | Radiation Oncology Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
ROBERT
RHYMER
Title or Position: COO OF CONTROLLING MEMBER
Credential:
Phone: 615-467-7415