=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699968719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILBERT M. JAMES, OD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2007
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 LEGACY WAY SUITE D
-----------------------------------------------------
City | ADAIRSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30103-2454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-773-1584
-----------------------------------------------------
Fax | 770-773-2773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 LEGACY WAY SUITE D
-----------------------------------------------------
City | ADAIRSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30103-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-773-1584
-----------------------------------------------------
Fax | 770-773-2773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | MR. GILBERT M. JAMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-773-1584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1178
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------