Healthcare Provider Details

I. General information

NPI: 1770722431
Provider Name (Legal Business Name): SATILLA REGIONAL CANCER TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SEYMOUR AVE
DOUGLAS GA
31533-1917
US

IV. Provider business mailing address

PO BOX 24650
JACKSONVILLE FL
32241-4650
US

V. Phone/Fax

Practice location:
  • Phone: 912-383-0815
  • Fax: 912-383-0826
Mailing address:
  • Phone: 904-260-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number055248
License Number StateGA

VIII. Authorized Official

Name: LINDA TURNER
Title or Position: VICE PRESIDENT
Credential:
Phone: 478-272-2255