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General NPI Number Information
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NPI Number | 1154453058
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Entity Type | Organization
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Legal Business Name | EAST GEORGIA CANCER CENTER
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1601 FAIR RD #900
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City | STATESBORO
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State | GA
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Zip | 30458-1698
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Country | US
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Telephone | 912-871-8000
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Fax | 912-871-3030
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Provider Business Mailing Address
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Address Line | PO BOX 397
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City | STATESBORO
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State | GA
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Zip | 30459-0397
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Country | US
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Telephone | 912-871-8000
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Fax | 912-871-3030
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Authorized Official
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Title or Position | M.D.
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Name | DR. HARSH BHUSHAN
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Credential | M.D.
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Telephone | 912-871-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 051780
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License Number State | GA
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