Provider Demographics
NPI:1366423915
Name:NORTH ATLANTA RADIATION ONCOLOGY
Entity type:Organization
Organization Name:NORTH ATLANTA RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-851-7004
Mailing Address - Street 1:PO BOX 409531
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9531
Mailing Address - Country:US
Mailing Address - Phone:770-693-6022
Mailing Address - Fax:770-693-6039
Practice Address - Street 1:SAINT JOSEPH'S HOSPITAL
Practice Address - Street 2:5665 PEACHTREE DUNWOODY ROAD
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-851-7004
Practice Address - Fax:404-851-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP1996Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER