Healthcare Provider Details

I. General information

NPI: 1922218692
Provider Name (Legal Business Name): DNK HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 N PARK PL SE SUITE 310P
ATLANTA GA
30339-7801
US

IV. Provider business mailing address

25 EQUESTRIAN WAY NE
CARTERSVILLE GA
30121-8032
US

V. Phone/Fax

Practice location:
  • Phone: 404-323-2020
  • Fax: 404-412-2020
Mailing address:
  • Phone: 404-323-2020
  • Fax: 404-412-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberLDO1683
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO1683
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberGA1683
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberGA1683
License Number StateGA

VIII. Authorized Official

Name: MR. DAN L MYER
Title or Position: PRACTITIONER
Credential: FCLSA, LDO
Phone: 404-323-2020