Healthcare Provider Details

I. General information

NPI: 1013786458
Provider Name (Legal Business Name): GWINNETT URGENT EYE CARE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 PEACHTREE INDUSTRIAL BLVD STE 100
DULUTH GA
30096-5032
US

IV. Provider business mailing address

3840 PEACHTREE INDUSTRIAL BLVD STE 100
DULUTH GA
30096-5032
US

V. Phone/Fax

Practice location:
  • Phone: 678-585-1901
  • Fax: 678-691-2139
Mailing address:
  • Phone: 678-585-1901
  • Fax: 678-691-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN UME
Title or Position: OWNER
Credential: MD
Phone: 678-585-1901