Provider Demographics
NPI:1275708786
Name:SN GWINETT COUNTY RADIATION
Entity type:Organization
Organization Name:SN GWINETT COUNTY RADIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVISCOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-682-2080
Mailing Address - Street 1:53 PERIMETER CTR E
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2294
Mailing Address - Country:US
Mailing Address - Phone:770-682-2080
Mailing Address - Fax:678-587-9275
Practice Address - Street 1:2094 MCGEE RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2911
Practice Address - Country:US
Practice Address - Phone:770-979-3705
Practice Address - Fax:770-979-3706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOTHERAPY CLINICS OF GEORGIA,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty