GEORGIA CANCER TREATMENT AND HEMATOLOGY CENTER (NPI# 1811977648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811977648 |
| Entity Type | Organization |
| Organization Name | GEORGIA CANCER TREATMENT AND HEMATOLOGY CENTER |
| Practice Address |
1279 Hwy 54 W Suite 210 Fayetteville GA 30215 |
| Mailing Address |
483 Upper Riverdale Rd Ste E Riverdale GA 30274 |
| Practice Telephone | 7707191299 |
| Practice Fax Number | 7707199244 |
| Mailing Telephone | 7709091550 |
| Mailing Fax Number | 7709091535 |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. GERALD ALAN GOLDKLANG (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7707191299 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
020714 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00188801C | 05 | |
| DEA | BG6599059 | 01 |
| Street Address |
1279 HWY 54 W SUITE 210 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801370051 | Truly Nourished, LLC | Dietitian, Registered | 500 West Lanier Ave., Suite 908, Fayetteville, GA 30215 | 2018-09-23 |
| 1104343839 | Pandora G Brown | Specialist | 65 Black Watch Ct, Fayetteville, GA 30215 | 2017-08-23 |
| 1902264492 | Ty-re Lamont Dixon Sr. | Durable Medical Equipment & Medical Supplies | 220 Shoreline Dr., Fayetteville, GA 30215 | 2016-01-29 |
| 1962870030 | Matthew Christian Alvarez | Dentist | 113 Ebenezer Rd Ste 101, Fayetteville, GA 30215 | 2015-09-08 |
| 1831534346 | Kevin Tyler Goelz | Radiology | 605 Wentworth Ct, Fayetteville, GA 30215 | 2013-05-10 |
| 1518249739 | William J. Holcomb | Pharmacist | 880 Hwy 85 South, Fayetteville, GA 30215 | 2011-09-14 |
| 1407168131 | All Care Home Health Equipment, LLC | Durable Medical Equipment & Medical Supplies | 1000 Cooper Circle, Suite 201, Fayetteville, GA 30215 | 2010-07-10 |
| 1083854160 | Rachel Blanks | Licensed Practical Nurse | 170 Brookwood Lane, Fayetteville, GA 30215 | 2009-03-02 |
| 1093964975 | Brenda Carole Hayek | Nurse Practitioner | 735 Glynn Street S, Fayetteville, GA 30215 | 2008-09-16 |
| 1174700769 | Katheryn D. Mcdonell | Counselor | 110 Dawn Drive, Fayetteville, GA 30215 | 2008-01-25 |
| Find all providers in zip 30215 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710237185 | Hui Chen | Internal Medicine | 6387 Ramsey St Unit 140, Fayetteville, NC 28311-9442 | 2012-09-13 |
| 1548317340 | Lynsay Leighanne Brautnick | Internal Medicine | 3232 N North Hills Blvd, Fayetteville, AR 72703-4005 | 2007-01-04 |
| 1861558827 | Surajit Chaudhuri Md Pa | Internal Medicine | 1205 Cape Court, Suite B, Fayetteville, NC 28304-4404 | 2006-12-27 |
| 1649228651 | Jonathan Christopher Bender | Internal Medicine | 1265 Highway 54 W Ste 4200, Fayetteville, GA 30214 | 2006-05-04 |
| 1497727879 | Surajit Chaudhuri | Internal Medicine | 1205 Cape Ct, Suite B, Fayetteville, NC 28304-4404 | 2006-02-01 |
| 1952372120 | J Thaddeus Beck | Internal Medicine | 3232 N Northhills Blvd, Fayetteville, AR 72703-4005 | 2006-01-27 |
| 1497733992 | Daniel Joseph Carr | Internal Medicine | 132 Old Norton Rd, Suite 200, Fayetteville, GA 30215-4872 | 2006-01-04 |
| 1184602856 | Shyam L Khanwani | Internal Medicine | 132 Old Norton Rd Ste 200, Fayetteville, GA 30215-4873 | 2006-01-04 |
| 1215933239 | Trinity Hematology & Oncology Center Pa | Internal Medicine | 1209 Cape Ct, Fayetteville, NC 28304-4404 | 2005-06-23 |
| 1245661701 | Cumberland County Hospital System, Inc. | Internal Medicine | 6387 Ramsey Street, Suite 140, Fayetteville, NC 28311 | 2013-12-10 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30215 |
Please comment or provide details below to improve the information on GEORGIA CANCER TREATMENT AND HEMATOLOGY CENTER.
| 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.