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General NPI Number Information
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NPI Number | 1831268606
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Entity Type | Organization
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Legal Business Name | PIEDMONT CANCER INSTITUTE PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 1800 HOWELL MILL RD NW STE 775
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City | ATLANTA
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State | GA
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Zip | 30318-3186
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Country | US
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Telephone | 678-298-3228
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Fax | 678-298-3229
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Provider Business Mailing Address
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Address Line | 1800 HOWELL MILL RD NW STE 775
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City | ATLANTA
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State | GA
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Zip | 30318-3186
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Country | US
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Telephone | 678-298-3228
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Fax | 678-298-3229
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC DEAN MININBERG
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Credential | MD
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Telephone | 404-350-9853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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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 | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE008932
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License Number State | GA
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