MEDICARE: NSH CANCER INSTITUTE PROFESSIONAL SERVICES A LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1497006639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NSH CANCER INSTITUTE PROFESSIONAL SERVICES A LLC

Provider Business Mailing Address
First Line	:	1100 JOHNSON FERRY RD NE
Second Line	:	CENTER POINT I, SUITE 510
City	:	ATLANTA
State	:	GA
Zip	:	30342-1709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7813 SPIVEY STATION BLVD
Second Line	:	SUITE 210
City	:	JONESBORO
State	:	GA
Zip	:	30236-2900
Country	:	US
Telephone Number	:	770-507-0070
Fax Number	:

Authorized Official
Title or Position	:	VP OF ADMIN SERVICES AND CCO
Name	:	JORGE J HERNANDEZ
Credential	:
Telephone Number	:	404-851-6378

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	01/24/2014

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