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General NPI Number Information
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NPI Number | 1811977648
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Entity Type | Organization
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Legal Business Name | GEORGIA CANCER TREATMENT AND HEMATOLOGY CENTER
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1279 HWY 54 W SUITE 210
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City | FAYETTEVILLE
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State | GA
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Zip | 30215
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Country | US
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Telephone | 770-719-1299
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Fax | 770-719-9244
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Provider Business Mailing Address
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Address Line | 483 UPPER RIVERDALE RD STE E
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 770-909-1550
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Fax | 770-909-1535
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. GERALD ALAN GOLDKLANG
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Credential | MD
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Telephone | 770-719-1299
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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 | 020714
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License Number State | GA
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