Healthcare Provider Details

I. General information

NPI: 1710196589
Provider Name (Legal Business Name): SJC ONCOLOGY SERVICES - GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CANDLER DRIVE SUITE 100
SAVANNAH GA
31405-6023
US

IV. Provider business mailing address

PO BOX 11407 DEPT 1622
BIRMINGHAM AL
35246-1622
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-1700
  • Fax: 912-354-8545
Mailing address:
  • Phone: 912-352-1700
  • Fax: 912-352-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number61684
License Number StateGA

VIII. Authorized Official

Name: MR. GREGORY J SCHAACK
Title or Position: CFO, FINANCE
Credential:
Phone: 912-819-6162