Healthcare Provider Details

I. General information

NPI: 1336972710
Provider Name (Legal Business Name): KYLEA CARVER MCCAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 VISION DR
CORNELIA GA
30531-5737
US

IV. Provider business mailing address

71 TOWERING OAKS DR
CLEVELAND GA
30528-1970
US

V. Phone/Fax

Practice location:
  • Phone: 706-776-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003612
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: