Provider Demographics
NPI:1023216868
Name:SOLOMON, ANDREW WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAYNE
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-0027
Mailing Address - Country:US
Mailing Address - Phone:229-686-3937
Mailing Address - Fax:
Practice Address - Street 1:205 W MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2131
Practice Address - Country:US
Practice Address - Phone:229-686-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6337670001Medicare NSC