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General NPI Number Information
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NPI Number | 1851515225
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Entity Type | Organization
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Legal Business Name | KEESHA K HAMPTON OD PC
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Dates
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Enumeration Date | 04/13/2007
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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 | 770-445-3938
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Fax | 770-445-0127
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MRS. KEESHA K. HAMPTON
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Credential | OD
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Telephone | 770-445-3938
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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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