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General NPI Number Information
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NPI Number | 1336279140
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Entity Type | Organization
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Legal Business Name | ROCKDALE NEWTON HEMATOLOGY ONCOLOGY
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 4139 BAKER ST NE
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City | COVINGTON
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State | GA
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Zip | 30014-1405
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Country | US
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Telephone | 770-786-9499
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Fax |
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Provider Business Mailing Address
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Address Line | 4139 BAKER ST NE
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City | COVINGTON
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State | GA
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Zip | 30014-1405
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Country | US
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Telephone | 770-786-9499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANIL J DESAI
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Credential | MD
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Telephone | 770-786-9499
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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 | 035033
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License Number State | GA
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