Provider Demographics
NPI:1225097009
Name:JEFFRIES, AMY REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:REBECCA
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HIGHWAY 34 E STE 306
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2123
Mailing Address - Country:US
Mailing Address - Phone:770-252-1999
Mailing Address - Fax:
Practice Address - Street 1:3150 HIGHWAY 34 E STE 306
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2123
Practice Address - Country:US
Practice Address - Phone:770-252-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCGBPMedicare PIN