Healthcare Provider Details

I. General information

NPI: 1093842270
Provider Name (Legal Business Name): NORTH GEORGIA EYE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 JESSE JEWELL PARKWAY SUITE 100
GAINESVILLE GA
30501
US

IV. Provider business mailing address

1485 JESSE JEWELL PARKWAY SUITE 100
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-1711
  • Fax: 770-534-9158
Mailing address:
  • Phone: 770-534-1711
  • Fax: 770-534-9158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CANDICE DAVIS
Title or Position: CHIEF REVENUE CYCLE OFFICER
Credential:
Phone: 916-990-7590