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General NPI Number Information
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NPI Number | 1619150182
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Entity Type | Organization
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Legal Business Name | ONCOLOGY HEMATOLOGY CARE CENTER, INC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 501 RIVERSIDE DR
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City | WAYCROSS
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State | GA
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Zip | 31501-5316
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Country | US
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Telephone | 912-283-6152
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Fax | 912-283-5264
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Provider Business Mailing Address
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Address Line | 501 RIVERSIDE DR
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City | WAYCROSS
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State | GA
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Zip | 31501-5316
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Country | US
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Telephone | 912-283-6152
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Fax | 912-283-5264
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LATINA HEARD
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Credential | LPN
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Telephone | 912-283-6152
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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 | 036088
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License Number State | GA
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