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1689298457 NPI number — NORTHEAST GEORGIA OPHTHALMOLOGY, LLC

NPI Number: 1689298457
Health Care Provider/Practitioner: NORTHEAST GEORGIA OPHTHALMOLOGY, LLC

Information about “1689298457” NPI (NORTHEAST GEORGIA OPHTHALMOLOGY, LLC) exists in 1689298457 in HTML format HTML  |  1689298457 in plain Text format TXT  |  1689298457 in PDF (Portable Document Format) PDF  |  1689298457 in an XML format XML  formats.

NPI Number : 1689298457 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689298457",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTHEAST GEORGIA OPHTHALMOLOGY, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "195 14TH ST NE UNIT 805",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ATLANTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30309-2673",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-596-8605",
    "MailingAddressFaxNumber": "713-903-7907",
    "FirstLinePracticeLocationAddress": "1498 JESSE JEWELL PKWY SE STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GAINESVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30501-3874",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-596-8605",
    "PracticeLocationAddressFaxNumber": "713-903-7907",
    "EnumerationDate": "06/08/2020",
    "LastUpdateDate": "06/24/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REDDY",
    "AuthorizedOfficialFirstName": "VANDANA",
    "AuthorizedOfficialMiddleName": "C.",
    "AuthorizedOfficialTitle": "OWNER/PHYSICIAN",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "770-767-3937",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QS0132X",
        "TaxonomyName": "Ophthalmologic Surgery Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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