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General NPI Number Information
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NPI Number | 1902134810
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Entity Type | Organization
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Legal Business Name | CENTRAL GEORGIA CANCER CARE
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 114 SUTHERLIN DR SUITE C-2
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City | WARNER ROBINS
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State | GA
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Zip | 31088-2259
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Country | US
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Telephone | 478-287-6927
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Fax | 478-328-9899
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Provider Business Mailing Address
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Address Line | 114 SUTHERLIN DR SUITE C-2
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City | WARNER ROBINS
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State | GA
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Zip | 31088-2259
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Country | US
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Telephone | 478-287-6927
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Fax | 478-328-9899
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. AARON S DAVIS
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Credential | PHARM.D.
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Telephone | 478-314-1667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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