Healthcare Provider Details

I. General information

NPI: 1265410161
Provider Name (Legal Business Name): GREG R ATKINSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD MARTIN ARMY COMMUNITY HOSPITAL
FT. BENNING GA
31905
US

IV. Provider business mailing address

6600 VAN AALST BLVD MARTIN ARMY COMMUNITY HOSPITAL
FT. BENNING GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: