Provider Demographics
NPI:1144409418
Name:AMY JEFFRIES, O.D., P.C.
Entity Type:Organization
Organization Name:AMY JEFFRIES, O.D., P.C.
Other - Org Name:JEFFRIES EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-252-1999
Mailing Address - Street 1:185 GLENDA TRCE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3825
Mailing Address - Country:US
Mailing Address - Phone:770-252-1999
Mailing Address - Fax:770-502-1071
Practice Address - Street 1:185 GLENDA TRCE STE A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3825
Practice Address - Country:US
Practice Address - Phone:770-252-1999
Practice Address - Fax:770-502-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA-1847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV09089Medicare UPIN
GAGRP7673Medicare PIN