Provider Demographics
NPI:1174820781
Name:PAGE, JERRY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PEACHTREE ST NE STE 3650
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3934
Mailing Address - Country:US
Mailing Address - Phone:866-927-4759
Mailing Address - Fax:866-927-4759
Practice Address - Street 1:1075 PEACHTREE ST NE STE 3650
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3934
Practice Address - Country:US
Practice Address - Phone:866-927-4759
Practice Address - Fax:866-927-4759
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician