Healthcare Provider Details

I. General information

NPI: 1396084141
Provider Name (Legal Business Name): JULIAN ALEXANDER AYRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX P
MOUNTAIN CITY GA
30562-0913
US

IV. Provider business mailing address

PO BOX P
MOUNTAIN CITY GA
30562-0913
US

V. Phone/Fax

Practice location:
  • Phone: 404-983-4462
  • Fax:
Mailing address:
  • Phone: 404-983-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberGA 17770
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: