Healthcare Provider Details

I. General information

NPI: 1457573073
Provider Name (Legal Business Name): CANCER CARE SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD SUITE G03
DECATUR GA
30033
US

IV. Provider business mailing address

PO BOX 98446
ATLANTA GA
30359
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-6925
  • Fax: 404-501-6930
Mailing address:
  • Phone: 404-423-8881
  • Fax: 404-321-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number048205
License Number StateGA

VIII. Authorized Official

Name: TOSHA BALFOUR
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 404-501-6925