Provider Demographics
NPI:1902134810
Name:CENTRAL GEORGIA CANCER CARE
Entity Type:Organization
Organization Name:CENTRAL GEORGIA CANCER CARE
Other - Org Name:CENTRAL GEORGIA CANCER CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:478-314-1667
Mailing Address - Street 1:114 SUTHERLIN DR
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2259
Mailing Address - Country:US
Mailing Address - Phone:478-287-6927
Mailing Address - Fax:478-328-9899
Practice Address - Street 1:114 SUTHERLIN DR
Practice Address - Street 2:SUITE C-2
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2259
Practice Address - Country:US
Practice Address - Phone:478-287-6927
Practice Address - Fax:478-328-9899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL GEORGIA CANCER CARE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy