SOUTHERN RAD ONC LLC (NPI# 1679199392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679199392 |
| Entity Type | Organization |
| Organization Name | SOUTHERN RAD ONC LLC |
| Practice Address |
809 South Park Street Carrollton GA 30117 |
| Practice Telephone | 6788018746 |
| Practice Fax Number | 6788018746 |
| Mailing Telephone | 6788018746 |
| Mailing Fax Number | 6788018746 |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2020-06-18 |
| Authorized Official Name | BRENT ARTHUR HARRIS (OWNER) |
| Authorized Official Telephone | 4047965898 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| Street Address |
809 SOUTH PARK STREET |
| City | CARROLLTON |
| State | GA |
| Zip Code | 30117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093361404 | Eyedeal Eyecare LLC | Optometrist | 1735 S Us 27, Carrollton, GA 30117 | 2019-08-12 |
| 1710412473 | Janis James | Optometrist | 1735 S, Us-27, Walmart Vision Center, Carrollton, GA 30117 | 2017-05-01 |
| 1568881951 | Omar Hajmurad | Anesthesiology | 812 S Park St Ste 5, Carrollton, GA 30117 | 2014-04-14 |
| 1134550353 | Goodbodys Minor Med Express Care | Nurse Practitioner | 1670 South Park St., Carrollton, GA 30117 | 2013-12-13 |
| 1306187570 | Myriam C Vela-ortiz | Internal Medicine | 157 Clinic Ave Ste 203, Carrollton, GA 30117 | 2013-03-12 |
| 1891030201 | Air Evac Ems, Inc. | Ambulance | 827 Old Bremen Rd, Carrollton, GA 30117 | 2012-12-11 |
| 1952682486 | Angelic Wings Transport, Inc. | Non-emergency Medical Transport (VAN) | 362 B Columbia Drive, Carrollton, GA 30117 | 2011-08-29 |
| 1073819256 | Atlanta Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 812 South Park Street, Suite 2, Carrollton, GA 30117 | 2011-02-04 |
| 1255640348 | Amy Gilbert | Counselor | 515 Tanner St, Carrollton, GA 30117 | 2010-10-06 |
| 1316253743 | Nichole Ann Adamson | Occupational Therapist | 180 Martin St, Carrollton, GA 30117 | 2010-08-23 |
| Find all providers in zip 30117 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700887437 | James Richard Bland II | Radiology | 165 Clinic Ave, Carrollton, GA 30117-4413 | 2005-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962910679 | American Professional Associates LLC | Radiology | 33 Upper Riverdale Rd Sw Ste 105, Riverdale, GA 30274-2642 | 2018-01-16 |
| 1003324187 | American Professional Associates LLC | Radiology | 1136 Cleveland Ave Ste 119, East Point, GA 30344-3618 | 2018-01-11 |
| 1316387137 | Rakendu Prakash Shukla | Radiology | 148 Bill Carruth Pkwy Ste Ll30, Hiram, GA 30141-3768 | 2013-06-25 |
| 1023301082 | Jolinta Lin | Radiology | The Emory Clinic Dept of Radiation Oncology, 1365 Clifton Road, Ne, Atlanta, GA 30322-0001 | 2011-05-25 |
| 1679739825 | Charles Reginald Woods IIi | Radiology | 275 Professional Ct, Suite B, Riverdale, GA 30274-2531 | 2008-08-06 |
| 1003086216 | Coastal Radiation Oncology Assoc. | Radiology | 2500 Starling St Ste 107, Brunswick, GA 31520-4266 | 2008-03-04 |
| 1275710899 | Shannon Tucker Kahn | Radiology | 639 Kimberly Ln Ne, Atlanta, GA 30306-2224 | 2008-01-25 |
| 1295924801 | Brian Wise Weaver | Radiology | 1355 Heatherland Dr Sw, Atlanta, GA 30331-7460 | 2007-10-19 |
| 1225245798 | John W Devine, Md, PC | Radiology | 209 Pendleton Dr, Valdosta, GA 31602-1729 | 2007-05-16 |
| 1356475131 | Winburn Jackson Dickens | Radiology | 152 Monroe Hwy, Winder, GA 30680-0664 | 2007-03-15 |
| Find all providers with the same taxonomy | ||||
| City | CARROLLTON |
| Zip Code | 30117 |
Please comment or provide details below to improve the information on SOUTHERN RAD ONC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.