Healthcare Provider Details

I. General information

NPI: 1922490937
Provider Name (Legal Business Name): CANCER TREATMENT CENTERS OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-7016
  • Fax:
Mailing address:
  • Phone: 770-400-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. ALTOVISE TAMARA EWING
Title or Position: GENETIC COUNSELOR
Credential: PHD
Phone: 404-210-4702