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General NPI Number Information
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NPI Number | 1346436961
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Entity Type | Organization
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Legal Business Name | HUMBERTO FALLAS P.C.
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 69 GRIFFIN ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3138
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Country | US
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Telephone | 770-954-9898
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Fax | 770-954-9147
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Provider Business Mailing Address
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Address Line | 69 GRIFFIN ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3138
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Country | US
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Telephone | 770-954-9898
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Fax | 770-954-9147
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HUMBERTO C FALLAS
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Credential | O.D.
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Telephone | 678-725-0690
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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 | OPT001975
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License Number State | GA
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