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General NPI Number Information
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NPI Number | 1417260142
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Entity Type | Organization
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Legal Business Name | BIRDSONG EYE CARE LLC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 850 DOGWOOD RD SUITE A-300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7218
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Country | US
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Telephone | 770-736-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 850 DOGWOOD RD SUITE A-300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7218
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Country | US
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Telephone | 770-736-7774
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMILAH BIRDSONG
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Credential |
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Telephone | 770-736-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 002535
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License Number State | GA
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