Provider Demographics
NPI:1538183280
Name:NORTH GEORGIA RADIATION THERAPY
Entity type:Organization
Organization Name:NORTH GEORGIA RADIATION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-331-2706
Mailing Address - Street 1:320 KENNESTONE HOSP. BLVD LL1
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:770-331-2706
Mailing Address - Fax:678-721-5556
Practice Address - Street 1:320 KENNESTONE HOSP. BLVD LL1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-331-2706
Practice Address - Fax:678-721-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 25Medicare ID - Type Unspecified