Healthcare Provider Details

I. General information

NPI: 1154449643
Provider Name (Legal Business Name): AUGUSTA EYE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 STEVENS CREEK RD
AUGUSTA GA
30907-3201
US

IV. Provider business mailing address

905 STEVENS CREEK RD
AUGUSTA GA
30907-3201
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-6000
  • Fax: 706-722-7994
Mailing address:
  • Phone: 706-922-6000
  • Fax: 706-722-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE ROGERS
Title or Position: ADMINISTRATOR
Credential: COE
Phone: 706-922-6000