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General NPI Number Information
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NPI Number | 1750663118
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN GYNECOLOGIC ONCOLOGY AT SAINT JOSEPH'S, LLC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 980 JOHNSON FERRY RD NE SUITE 900
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City | ATLANTA
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State | GA
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Zip | 30342-1609
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Country | US
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Telephone | 678-420-4100
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Fax | 678-420-4111
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Provider Business Mailing Address
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Address Line | 980 JOHNSON FERRY ROAD, SUITE 900
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City | ATLANTA
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State | GA
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Zip | 30342-1609
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Country | US
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Telephone | 678-420-4100
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Fax | 678-420-4111
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD D REED
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Credential |
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Telephone | 678-843-6409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology 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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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