Organization
SOUTHEAST RADIATION ONCOLOGY GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL A WILLIAMS M.S.P.H. (ADMINISTRATOR)
(704) 333-7376
Entity
Organization
Contact information
Practice address
200 QUEENS RD, SUITE 400, CHARLOTTE, NC 28204-3252
(704) 333-7376
(704) 333-3397
Mailing address
200 QUEENS RD, SUITE 400, CHARLOTTE, NC 28204-3252
(704) 333-7376
(704) 333-3397
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01351
BLUE CROSS
NC
01
—
131977
UNITED HEALTHCARE
—
05
—
8901351
—
NC
05
—
NPA534
—
SC
Enumeration date
06/04/2006
Last updated
01/26/2010
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