=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053591966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBUS RADIATION ONCOLOGY ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2007
-----------------------------------------------------
Last Update Date | 12/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 WARM SPRINGS RD STE B
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-7954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-660-8121
-----------------------------------------------------
Fax | 706-323-4205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 WARM SPRINGS RD STE B
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-7954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-660-8121
-----------------------------------------------------
Fax | 706-323-4205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING REPRESENTATIVE
-----------------------------------------------------
Name | MRS. AMY MCCOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-660-8121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0203X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Clinic/Center
-----------------------------------------------------
License Number | 18964
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------