Healthcare Provider Details

I. General information

NPI: 1407035652
Provider Name (Legal Business Name): GEORGIA CANCER SPECIALISTS I PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 BILL CARRUTH PARKWAY SUITE 300
HIRAM GA
30141
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 770-443-6019
  • Fax: 770-443-6532
Mailing address:
  • Phone: 770-496-9400
  • Fax: 770-496-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WENDY HAWKE LENZ
Title or Position: COO
Credential: MD
Phone: 770-496-5555