Provider Demographics
NPI:1336281971
Name:N.E. GA VISION CARE, LLC
Entity Type:Organization
Organization Name:N.E. GA VISION CARE, LLC
Other - Org Name:JENKINS VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-208-9491
Mailing Address - Street 1:3654 ATLANTA HWY STE B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6979
Mailing Address - Country:US
Mailing Address - Phone:706-208-9491
Mailing Address - Fax:706-543-8912
Practice Address - Street 1:3654 ATLANTA HWY STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6979
Practice Address - Country:US
Practice Address - Phone:706-208-9491
Practice Address - Fax:706-543-8912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N.E. GA VISION CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP8049Medicare ID - Type Unspecified