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General NPI Number Information
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NPI Number | 1528228616
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Entity Type | Organization
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Legal Business Name | STONE MOUNTAIN EYE CENTER
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 1525 E PARK PLACE BLVD STE 1800
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6403
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Country | US
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Telephone | 770-498-3434
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Fax | 770-498-3440
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Provider Business Mailing Address
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Address Line | 1525 E PARK PLACE BLVD STE 1800
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6403
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Country | US
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Telephone | 770-498-3434
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Fax | 770-498-3440
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIZABETH SOBANJO
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Credential | O.D
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Telephone | 770-498-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1538
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License Number State | GA
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