Provider Demographics
NPI:1205857968
Name:MARIETTA EYE CLINIC, PA
Entity Type:Organization
Organization Name:MARIETTA EYE CLINIC, PA
Other - Org Name:MARIETTA EYE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:GATEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-8111
Mailing Address - Street 1:895 CANTON RD NE
Mailing Address - Street 2:BUILDING 200, SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8934
Mailing Address - Country:US
Mailing Address - Phone:678-784-0203
Mailing Address - Fax:
Practice Address - Street 1:895 CANTON RD NE
Practice Address - Street 2:BUILDING 200, SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:678-784-0203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery