Healthcare Provider Details

I. General information

NPI: 1003993965
Provider Name (Legal Business Name): EYE CONSULTANTS OF ATLANTA PIEDMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW SUITE 100
ATLANTA GA
30327-2119
US

IV. Provider business mailing address

3193 HOWELL MILL RD NW SUITE 100
ATLANTA GA
30327-2119
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1410
  • Fax: 404-350-1416
Mailing address:
  • Phone: 404-350-1410
  • Fax: 404-350-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA BROOKS
Title or Position: FACILITY COORDINATOR
Credential:
Phone: 404-350-1410