Healthcare Provider Details

I. General information

NPI: 1467672873
Provider Name (Legal Business Name): SOUTH ATLANTIC RADIATION ONCOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 OCEAN HIGHWAY WEST
SUPPLY NC
28462
US

IV. Provider business mailing address

PO BOX 3245
WILMINGTON NC
28406-0245
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-4716
  • Fax:
Mailing address:
  • Phone: 910-251-1839
  • Fax: 910-251-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. MICHAEL ALEX PAPAGIKOS
Title or Position: MEMBER
Credential: MD
Phone: 910-662-8440