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General NPI Number Information
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NPI Number | 1316193626
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Entity Type | Organization
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Legal Business Name | PHOEBE CANCER CENTER SURGICAL ONCOLOGY
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 409 W 4TH AVE
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City | ALBANY
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State | GA
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Zip | 31701-1915
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Country | US
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Telephone | 229-312-5080
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Fax | 229-312-5085
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Provider Business Mailing Address
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Address Line | 409 W 4TH AVE
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City | ALBANY
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State | GA
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Zip | 31701-1915
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Country | US
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Telephone | 229-312-5080
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Fax | 229-312-5085
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Authorized Official
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Title or Position | SENIOR VP
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Name | FRANK F MIDDLETON III
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Credential | MD
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Telephone | 229-312-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 046876
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License Number State | GA
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