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General NPI Number Information
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NPI Number | 1588890487
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Entity Type | Organization
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Legal Business Name | THE GEORGIA CENTER FOR TOTAL CANCER CARE OF HILLANDALE
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 2745 DEKALB MEDICAL PKWY SUITE 100
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City | LITHONIA
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State | GA
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Zip | 30058
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Country | US
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Telephone | 770-350-0126
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 PRESTON RIDGE DRIVE SUITE 300
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City | ALPHARETTA
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State | GA
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Zip | 30005
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Country | US
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Telephone | 770-350-0126
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DALE LYNN MCCORD
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Credential | M.D.
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Telephone | 770-350-0126
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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 |
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License Number State |
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