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General NPI Number Information
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NPI Number | 1720499304
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Entity Type | Organization
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Legal Business Name | EAST GEORGIA CANCER CLINIC
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/17/2014
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Provider Practice Location Address
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Address Line | 1601 FAIR RD #900
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City | STATESBORO
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State | GA
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Zip | 30458-1698
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Country | US
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Telephone | 912-871-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 FAIR RD #900
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City | STATESBORO
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State | GA
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Zip | 30458
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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 | SECRETARY
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Name | MR. HARSH BHUSHAN
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Credential |
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Telephone | 912-871-8000
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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 | 51780
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License Number State | GA
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