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General NPI Number Information
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NPI Number | 1609127778
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Entity Type | Organization
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Legal Business Name | NSH CANCER INSTITUTE PROFESSIONAL SERVICES G, LLC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 4586 TIMBER RIDGE DR SUITE 200
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7517
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Country | US
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Telephone | 770-842-0457
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 SAVOY DR SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30341-1072
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OF ADMIN SERVICES AND CCO
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Name | JORGE J HERNANDEZ
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Credential |
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Telephone | 404-851-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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