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General NPI Number Information
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NPI Number | 1679996425
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Entity Type | Organization
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Legal Business Name | GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC.
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 605 S VETERANS BLVD
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City | GLENNVILLE
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State | GA
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Zip | 30427-1775
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Country | US
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Telephone | 912-654-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 WATERS AVE
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City | SAVANNAH
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State | GA
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Zip | 31404-6292
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Country | US
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Telephone | 912-354-4800
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KATHY HEGAN
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Credential |
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Telephone | 912-629-5929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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