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General NPI Number Information
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NPI Number | 1750480380
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Entity Type | Organization
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Legal Business Name | TALLAHASSEE GYN-ONCOLOGY LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 2770 CAPITAL MEDICAL BLVD SUITE 210
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City | TALLAHASSEE
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State | FL
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Zip | 32308-8417
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Country | US
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Telephone | 850-877-7392
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Fax | 850-877-1535
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Provider Business Mailing Address
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Address Line | PO BOX 100196
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City | ATLANTA
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State | GA
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Zip | 30384-0196
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Country | US
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Telephone | 808-780-5134
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Fax | 850-784-7706
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MICKEY S PICKLER
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Credential |
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Telephone | 850-523-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | ME96687
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License Number State | FL
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