Healthcare Provider Details

I. General information

NPI: 1922176627
Provider Name (Legal Business Name): CHEROKEE EYE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 E MAIN ST
CANTON GA
30114-2801
US

IV. Provider business mailing address

591 E MAIN ST
CANTON GA
30114-2801
US

V. Phone/Fax

Practice location:
  • Phone: 770-479-4481
  • Fax: 770-479-8932
Mailing address:
  • Phone: 770-479-4481
  • Fax: 770-479-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOYCE M NATIONS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 770-479-4481