Healthcare Provider Details

I. General information

NPI: 1659636694
Provider Name (Legal Business Name): THOMAS EYE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PEACHTREE INDUSTRIAL BLVD STE 101
SUWANEE GA
30024-2013
US

IV. Provider business mailing address

5901A PEACHTREE DUNWOODY RD STE 500
ATLANTA GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 678-892-2020
  • Fax: 678-538-1972
Mailing address:
  • Phone: 678-781-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN S BONNETT
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 678-781-7373