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General NPI Number Information
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NPI Number | 1811094246
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Entity Type | Individual
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Provider Name | KEESHA K. HAMPTON O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 3615 CHARLES HARDY PKWY
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City | DALLAS
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State | GA
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Zip | 30157-9472
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Country | US
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Telephone | 770-445-3938
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Fax | 770-445-0127
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Provider Business Mailing Address
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Address Line | 935 QUEENSBROOKE WAY
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City | MABLETON
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State | GA
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Zip | 30126-6413
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Country | US
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Telephone | 678-945-4673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | GAOPT002236
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License Number State | GA
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