Healthcare Provider Details

I. General information

NPI: 1902870751
Provider Name (Legal Business Name): DOUGLASVILLE EYE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 PROFESSIONAL PKWY SUITE 2040
DOUGLASVILLE GA
30134-5632
US

IV. Provider business mailing address

6001 PROFESSIONAL PKWY SUITE 2040
DOUGLASVILLE GA
30134-5632
US

V. Phone/Fax

Practice location:
  • Phone: 678-838-9999
  • Fax: 678-838-9474
Mailing address:
  • Phone: 678-838-9999
  • Fax: 678-838-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0606334
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0606334
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID S HEMMINGS
Title or Position: PRESIDENT
Credential: MD
Phone: 678-838-9999