MEDICARE: XPERIENCE DREVAGEE

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1851084933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XPERIENCE DREVAGEE

Provider Business Mailing Address
First Line	:	2451 CUMBERLAND PKWY SE STE 3809
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6136
Country	:	US
Telephone Number	:	678-522-1093
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 WENDY BAGWELL PKWY STE 32
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2885
Country	:	US
Telephone Number	:	678-522-1093
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY KNOWLIN
Credential	:
Telephone Number	:	678-522-1093

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “XPERIENCE DREVAGEE ” Practice Location

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