Healthcare Provider Details

I. General information

NPI: 1669663365
Provider Name (Legal Business Name): CENTER OF HOPE FOR CANCERS AND BLOOD DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 UPPER RIVERDALE RD SW STE 3-4
RIVERDALE GA
30274-2529
US

IV. Provider business mailing address

PO BOX 1710
STOCKBRIDGE GA
30281-8710
US

V. Phone/Fax

Practice location:
  • Phone: 770-629-2337
  • Fax: 770-629-5194
Mailing address:
  • Phone: 770-629-2337
  • Fax: 770-629-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number053348
License Number StateGA

VIII. Authorized Official

Name: DR. ANTHONY C ONYEGBULA
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 770-629-2337