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General NPI Number Information
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NPI Number | 1003255597
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Entity Type | Organization
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Legal Business Name | P&D FAMILY, LLC
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 860 PEACHTREE ST NE SUITE F
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City | ATLANTA
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State | GA
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Zip | 30308-1249
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Country | US
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Telephone | 404-853-5008
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Fax | 404-853-5009
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Provider Business Mailing Address
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Address Line | 860 PEACHTREE ST NE SUITE F
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City | ATLANTA
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State | GA
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Zip | 30308-1249
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Country | US
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Telephone | 404-853-5008
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Fax | 404-853-5009
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DIVYA BHAKTA
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Credential | O.D.
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Telephone | 678-778-1985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002708
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License Number State | GA
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