Healthcare Provider Details

I. General information

NPI: 1124519954
Provider Name (Legal Business Name): GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD STE 806
POOLER GA
31322-4070
US

IV. Provider business mailing address

4720 WATERS AVE
SAVANNAH GA
31404-6292
US

V. Phone/Fax

Practice location:
  • Phone: 912-450-3500
  • Fax: 912-629-5821
Mailing address:
  • Phone: 912-354-4800
  • Fax: 912-629-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA LEIGH MORELAND
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 912-354-4800