Healthcare Provider Details
I. General information
NPI: 1598893471
Provider Name (Legal Business Name): GREATER ATLANTA RADIATION ONCOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/01/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2675 N DECATUR RD SUITE G03
DECATUR GA
30033-6131
US
IV. Provider business mailing address
179 WORTHINGTON WAY
JONESBORO GA
30236-5588
US
V. Phone/Fax
- Phone: 404-501-6925
- Fax: 404-501-6930
- Phone: 404-704-5887
- Fax: 678-565-0606
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0203X |
| Taxonomy | Therapeutic Radiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
TONYA
ECHOLS
COLE
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 404-501-6925