Healthcare Provider Details

I. General information

NPI: 1356374847
Provider Name (Legal Business Name): EMORY EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE SUITE B-3402
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1205 MCCONNELL DR
DECATUR GA
30033-3501
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4120
  • Fax: 404-778-4380
Mailing address:
  • Phone: 404-315-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JIONG YAN
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 404-778-4120