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General NPI Number Information
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NPI Number | 1649736752
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Entity Type | Organization
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Legal Business Name | PROTON INTERNATIONAL ALABAMA, LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 400 20TH STREET SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35233
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Country | US
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Telephone | 630-649-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 922 HAWKHORN CT
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City | ALPHARETTA
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State | GA
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Zip | 30005-4358
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Country | US
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Telephone | 630-649-4060
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Fax | 312-896-9537
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MR. CHARLES YOO
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Credential |
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Telephone | 630-649-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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