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General NPI Number Information
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NPI Number | 1447387774
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Entity Type | Organization
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Legal Business Name | T. T UNDERWOOD, INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 805 COMMERCE DR SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30094-6606
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Country | US
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Telephone | 770-483-4831
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Fax | 770-483-4840
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Provider Business Mailing Address
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Address Line | 805 COMMERCE DR SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30094-6606
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Country | US
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Telephone | 770-483-4831
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Fax | 770-483-4840
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KRISTI L SHEROD
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Credential |
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Telephone | 770-483-4831
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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 | GA1622
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License Number State | GA
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