Healthcare Provider Details

I. General information

NPI: 1053304675
Provider Name (Legal Business Name): GEORGETOWN RADIATION THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N FRASER ST
GEORGETOWN SC
29440-6410
US

IV. Provider business mailing address

PO DRAWER 1718
GEORGETOWN SC
29442-1718
US

V. Phone/Fax

Practice location:
  • Phone: 843-545-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WARD
Title or Position: EXECUTIVE VICE PRESIDENT/CHIEF FINA
Credential:
Phone: 843-527-7102