Provider Demographics
NPI:1164614996
Name:ATKINSON, GARY BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRIAN
Last Name:ATKINSON
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 1:230 KYLAS WAY
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-3884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 CARLTON STREET
Practice Address - Street 2:UGA UNIVERSITY HEALTH CENTER
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1755
Practice Address - Country:US
Practice Address - Phone:706-542-5617
Practice Address - Fax:706-227-4763
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B29-TA-734152W00000X
GAOPT002445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist