Provider Demographics
NPI:1003993965
Name:EYE CONSULTANTS OF ATLANTA PIEDMONT
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF ATLANTA PIEDMONT
Other - Org Name:PIEDMONT EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-350-1410
Mailing Address - Street 1:3193 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2119
Mailing Address - Country:US
Mailing Address - Phone:404-350-1410
Mailing Address - Fax:404-350-1416
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-350-1410
Practice Address - Fax:404-350-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207W00000X
261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000950111AMedicaid
GA111203ASCAOtherMEDICARE ID
GA000950111AMedicaid
GAC30849Medicare PIN
GA000950111AMedicaid