Healthcare Provider Details

I. General information

NPI: 1487577219
Provider Name (Legal Business Name): COURTNEY LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 TARA BLVD
HAMPTON GA
30228
US

IV. Provider business mailing address

3043 TURNER CHURCH RD
MCDONOUGH GA
30252-2818
US

V. Phone/Fax

Practice location:
  • Phone: 770-707-0711
  • Fax:
Mailing address:
  • Phone: 678-510-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003763
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: