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NPI Code Detail

MEDICARE: GEORGIA OPHTHALMOLOGISTS LLC

MEDICARE: GEORGIA OPHTHALMOLOGISTS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center107-075GA

General Provider Information

NPI Number : 1477831360
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA OPHTHALMOLOGISTS LLC
Provider Business Mailing Address
First Line : PO BOX 2898
Second Line :
City : COVINGTON
State : GA
Zip : 30015-7898
Country : US
Telephone Number : 770-786-1234
Fax Number : 678-712-6977
Provider Business Practice Location Address
First Line : 4159 MILL ST NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2546
Country : US
Telephone Number : 770-786-1234
Fax Number : 678-712-6977
Authorized Official
Title or Position : ADMINISTRATOR
Name : MISS STACY BIGLES
Credential :
Telephone Number : 770-786-1234
Provider Enumeration Date : 07/27/2011
Last Update Date : 02/04/2016

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Directions to “GEORGIA OPHTHALMOLOGISTS LLC ” Practice Location

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