Healthcare Provider Details

I. General information

NPI: 1053061747
Provider Name (Legal Business Name): GWINNETT OPHTHALMOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
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: 678-691-2138
Mailing address:
  • Phone: 678-585-1901
  • Fax: 678-691-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN UME
Title or Position: OWNER
Credential: MD
Phone: 562-233-8441