NPIMap

Organization Active NPI

Georgia Cancer Treatment and Hematology Center

  • Hematology & Oncology Physician
  • Fayetteville, GA
National Provider Identifier
1811977648
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
020714 Issued in GA
Legal business name
GEORGIA CANCER TREATMENT AND HEMATOLOGY CENTER
Practice address
1279 Hwy 54 W
Suite 210
Fayetteville, GA 30215
Phone
(770) 719-1299
Fax
(770) 719-9244
NPI assigned
Jan 18, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gerald Alan Goldklang, MDNPI 1912955840
Title
Medical Director
Phone
(770) 719-1299

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 020714 GA Primary

Addresses

Primary practice location

1279 Hwy 54 W
Suite 210
Fayetteville, GA 30215

Mailing address

483 Upper Riverdale Rd
Ste E
Riverdale, GA 30274
Phone (770) 909-1550

Other identifiers 1

IdentifierTypeStateIssuer
00188801CMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1811977648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "483 UPPER RIVERDALE RD",
            "address_2": "STE E",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "30274",
            "telephone_number": "770-909-1550",
            "fax_number": "770-909-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 HWY 54 W",
            "address_2": "SUITE 210",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30215",
            "telephone_number": "770-719-1299",
            "fax_number": "770-719-9244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA CANCER TREATMENT AND HEMATOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GOLDKLANG",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-719-1299",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "020714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00188801C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.