Organization
EAST GEORGIA CANCER CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARSH BHUSHAN (SECRETARY)
(912) 871-8000
Entity
Organization
Contact information
Practice address
1601 FAIR RD, #900, STATESBORO, GA 30458-1698
(912) 871-8000
Mailing address
1601 FAIR RD, #900, STATESBORO, GA 30458
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
51780
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000958823
—
GA
Enumeration date
05/16/2014
Last updated
05/17/2014
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