Healthcare Provider Details

I. General information

NPI: 1780254763
Provider Name (Legal Business Name): ESOG ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLEVELAND AVE SW STE 616
ATLANTA GA
30315-7116
US

IV. Provider business mailing address

777 CLEVELAND AVE SW STE 616
ATLANTA GA
30315-7116
US

V. Phone/Fax

Practice location:
  • Phone: 404-766-6268
  • Fax:
Mailing address:
  • Phone: 404-766-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE ALEXANDER
Title or Position: BILLING MANAGER
Credential:
Phone: 404-766-6268