Healthcare Provider Details

I. General information

NPI: 1346453685
Provider Name (Legal Business Name): ATHENS RETINA CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 JEFFERSON RD
ATHENS GA
30607-1208
US

IV. Provider business mailing address

2705 JEFFERSON RD
ATHENS GA
30607-1208
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-3200
  • Fax: 706-433-1745
Mailing address:
  • Phone: 706-543-3200
  • Fax: 706-433-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number059245
License Number StateGA

VIII. Authorized Official

Name: DR. MOHAN NARAYANASWAMY IYER
Title or Position: OWNER
Credential: M.D.
Phone: 706-543-3200