Organization · Type 2 NPI

LW Gwinnett County Radiation

Specialist · Lawrenceville, GA

NPI number 1104091602 Active

Practice location

311 Philip Blvd
Lawrenceville, GA 30045-8733

Call (770) 995-3000 Map

Fax (770) 995-1427

Mailing address

53 Perimeter Ctr E, Suite 500
Atlanta, GA 30346-2294

Specialties and licenses

Taxonomy	Code	License
Specialist Primary	174400000X	46327 (GA)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

2 other providers at this address

Other specialist providers in Lawrenceville

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NPI record

NPI: 1104091602
Entity type: Organization (Type 2)
Issued: Apr 25, 2008
Last updated: Apr 25, 2008
Status: Active
Subpart: Yes of Radiotherapy Clinics of Georgia,llc

Other names

<unavail>
Radiotherapy Clinics of Georgia · other name

Authorized official

Tammie Laviscount
Contract Analyst
(770) 682-2080

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104091602

LW Gwinnett County Radiation's National Provider Identifier is 1104091602, issued on Apr 25, 2008. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Lawrenceville, GA. The record was last updated on Apr 25, 2008.