Healthcare Provider Details

I. General information

NPI: 1043380108
Provider Name (Legal Business Name): RADIATION ONCOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 HOSPITAL BLVD
JACKSON TN
38305-2079
US

IV. Provider business mailing address

322 HOSPITAL BLVD
JACKSON TN
38305-2079
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-1668
  • Fax: 731-668-5801
Mailing address:
  • Phone: 731-668-1668
  • Fax: 731-668-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN CAIN HARDIN
Title or Position: CFO
Credential:
Phone: 731-668-1668