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General NPI Number Information
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NPI Number | 1255773347
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Entity Type | Organization
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Legal Business Name | ATLANTA EYE ASSOCIATES
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 5456 JIMMY CARTER BLVD STE 180
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City | NORCROSS
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State | GA
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Zip | 30093-1545
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Country | US
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Telephone | 404-355-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 5456 JIMMY CARTER BLVD STE 180
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City | NORCROSS
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State | GA
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Zip | 30093-1545
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Country | US
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Telephone | 404-355-2600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KIM RAHARJA
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Credential | OD
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Telephone | 404-355-2600
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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 | OPT002319
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License Number State | GA
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