Provider Demographics
NPI:1093077984
Name:SOUTH GEORGIA EYE PARTNERS
Entity Type:Organization
Organization Name:SOUTH GEORGIA EYE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-391-4126
Mailing Address - Street 1:4380 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6921
Mailing Address - Country:US
Mailing Address - Phone:229-244-2068
Mailing Address - Fax:229-244-2850
Practice Address - Street 1:416 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4466
Practice Address - Country:US
Practice Address - Phone:229-391-4180
Practice Address - Fax:229-391-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty