=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477688067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE KIMMONS-DOTY OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6628 HWY 53 E
-----------------------------------------------------
City | DAWSONVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-216-7732
-----------------------------------------------------
Fax | 706-216-7733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6628 HIGHWAY 53 E
-----------------------------------------------------
City | DAWSONVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30534-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-216-7732
-----------------------------------------------------
Fax | 706-216-7733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | T1164
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------