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General NPI Number Information
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NPI Number | 1154732824
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Entity Type | Organization
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Legal Business Name | COWETA EYE ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 15 RUTH DR SUITE C
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City | NEWNAN
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State | GA
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Zip | 30265-2317
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Country | US
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Telephone | 770-683-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 15 RUTH DR SUITE C
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City | NEWNAN
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State | GA
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Zip | 30265-2317
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Country | US
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Telephone | 770-683-2733
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY H LAMBERT
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Credential | OD
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Telephone | 770-683-2733
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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 | OPT002186
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License Number State | GA
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