Healthcare Provider Details

I. General information

NPI: 1972435170
Provider Name (Legal Business Name): MRS. AMBER LISET RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS AMBER LISET ALMONTE

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 COBB PKWY S
MARIETTA GA
30060-9288
US

IV. Provider business mailing address

5590 MABLETON PKWY SW STE 138-109
MABLETON GA
30126-3344
US

V. Phone/Fax

Practice location:
  • Phone: 770-955-5019
  • Fax: 770-955-7349
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO003143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: