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General NPI Number Information
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NPI Number | 1417115817
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Entity Type | Organization
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Legal Business Name | VIDALIA REGIONAL CANCER CENTER
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 1707 MEADOWS LN SUITE C
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City | VIDALIA
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State | GA
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Zip | 30474-7200
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Country | US
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Telephone | 912-538-7777
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Fax | 912-538-7070
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Provider Business Mailing Address
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Address Line | 1707 MEADOWS LN SUITE C
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City | VIDALIA
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State | GA
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Zip | 30474-7200
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Country | US
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Telephone | 912-538-7777
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Fax | 912-538-7070
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Authorized Official
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Title or Position | CONTROLLER
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Name | TONY O'STEEN
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Credential |
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Telephone | 912-538-5857
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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 | 060835
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License Number State | GA
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