Organization
THERAPEUTIC RADIATION ONCOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELDA H CHAMPAGNE (BILLING MANAGER)
(770) 907-0554
Entity
Organization
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-5850
(770) 719-5849
Mailing address
255 PROFESSIONAL CT, RIVERDALE, GA 30274-2531
(770) 907-0554
(770) 907-9048
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629019534
NPI
GA
05
—
300021609A
—
GA
Enumeration date
06/10/2006
Last updated
12/27/2021
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