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General NPI Number Information
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NPI Number | 1023821535
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Entity Type | Organization
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Legal Business Name | THE ATLANTA CORNEA CARE CENTER - DR. KENYATTA BRANTLEY, OPTOMETRIST (P.C.)
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 37 CALUMET PARKWAY BLDG G SUITE 101 ATTENTION: DR. KEN BRANTLEY
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City | NEWNAN
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State | GA
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Zip | 30263
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Country | US
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Telephone | 229-800-4712
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Fax |
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Provider Business Mailing Address
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Address Line | 37 CALUMET PARKWAY BLDG G SUITE 101 ATTENTION: DR. KEN BRANTLEY
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City | NEWNAN
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State | GA
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Zip | 30263
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Country | US
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Telephone | 229-800-4712
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. KENYATTA D. BRANTLEY
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Credential | OD
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Telephone | 229-800-4712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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