MEDICARE: KEESHA K HAMPTON OD PC

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	GAOPT002236	GA

General Provider Information

NPI Number	:	1851515225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEESHA K HAMPTON OD PC

Provider Business Mailing Address
First Line	:	935 QUEENSBROOKE WAY
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-6413
Country	:	US
Telephone Number	:	770-445-3938
Fax Number	:	770-445-0127

Provider Business Practice Location Address
First Line	:	3615 CHARLES HARDY PKWY
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-9472
Country	:	US
Telephone Number	:	770-445-3938
Fax Number	:	770-445-0127

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MRS. KEESHA K. HAMPTON
Credential	:	OD
Telephone Number	:	770-445-3938

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	12/13/2022

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