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General NPI Number Information
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NPI Number | 1508237561
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Entity Type | Organization
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Legal Business Name | CANCER CENTER OF MIDDLE GEORGIA
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 26 ERIN OFFICE PARK
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City | DUBLIN
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State | GA
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Zip | 31021
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Country | US
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Telephone | 478-272-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 BELLEVUE RD STE 26
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City | DUBLIN
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State | GA
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Zip | 31021-2893
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Country | US
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Telephone | 478-595-6530
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HARSHA VYAS
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Credential | MD
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Telephone | 478-272-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 64088
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License Number State | GA
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