Healthcare Provider Details

I. General information

NPI: 1194742288
Provider Name (Legal Business Name): CAROLINA SURGICAL ONCOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 BERMUDA RUN
STATESBORO GA
30458-0858
US

IV. Provider business mailing address

1 S COLLEGE ST
STATESBORO GA
30459-1807
US

V. Phone/Fax

Practice location:
  • Phone: 864-580-8033
  • Fax: 864-349-2145
Mailing address:
  • Phone: 864-580-8033
  • Fax: 864-349-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number27417
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL NELSON LUGO
Title or Position: PRESIDENT
Credential: MD
Phone: 864-580-8033