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General NPI Number Information
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NPI Number | 1700675568
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Entity Type | Organization
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Legal Business Name | MARIETTA EYE CLINIC PA
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 4025 JOHNS CREEK PKWY STE 200
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City | SUWANEE
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State | GA
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Zip | 30024-5683
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Country | US
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Telephone | 678-439-2450
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96837
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City | CHARLOTTE
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State | NC
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Zip | 28296-6837
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Country | US
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Telephone | 678-439-2450
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Fax |
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Authorized Official
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Title or Position | VP, CFO TPR
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Name | BRIAN RASMUS
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Credential |
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Telephone | 469-893-2532
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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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