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General NPI Number Information
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NPI Number | 1699022046
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Entity Type | Organization
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Legal Business Name | NEWNAN EYE CARE LLC
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Dates
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Enumeration Date | 08/04/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 1201 N PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1743
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Country | US
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Telephone | 404-861-7253
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 N PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1743
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Country | US
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Telephone | 404-861-7253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHY SAMUELS
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Credential | OD
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Telephone | 404-861-7253
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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 | GA1408
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License Number State | GA
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