MEDICARE: PRINCIPAL GROWTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	870T	GA

General Provider Information

NPI Number	:	1124171723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCIPAL GROWTH LLC

Provider Business Mailing Address
First Line	:	2184 HENDERSON MILL RD NE
Second Line	:	SUITE 12B
City	:	ATLANTA
State	:	GA
Zip	:	30345-3762
Country	:	US
Telephone Number	:	770-491-1255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2184 HENDERSON MILL RD NE
Second Line	:	SUITE 12B
City	:	ATLANTA
State	:	GA
Zip	:	30345-3762
Country	:	US
Telephone Number	:	770-491-1255
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CINDY STEWART
Credential	:	OD
Telephone Number	:	770-491-1255

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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