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General NPI Number Information
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NPI Number | 1033092366
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANTIC RETINA PLLC
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3627 UNIVERSITY BLVD S STE 605
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City | JACKSONVILLE
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State | FL
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Zip | 32216-7401
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Country | US
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Telephone | 904-658-0176
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 VALHALLA CT
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City | COLUMBIA
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State | MO
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Zip | 65203-4212
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Country | US
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Telephone | 904-658-0176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AHMED M ELKEEB
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Credential | MD, MBA
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Telephone | 904-658-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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