Healthcare Provider Details

I. General information

NPI: 1689833089
Provider Name (Legal Business Name): NW GEORGIA EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 HIGHWAY 76 SUITE A COHUTTA PLACE
CHATSWORTH GA
30705-7302
US

IV. Provider business mailing address

2120 HIGHWAY 76 SUITE A COHUTTA PLACE
CHATSWORTH GA
30705-7302
US

V. Phone/Fax

Practice location:
  • Phone: 706-695-0107
  • Fax: 706-517-9633
Mailing address:
  • Phone: 706-695-0107
  • Fax: 706-517-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES ALLEN CALLAWAY
Title or Position: O.D.
Credential: R.PH, O.D.
Phone: 706-695-0107