Provider Demographics
NPI:1346453685
Name:ATHENS RETINA CENTER PC
Entity Type:Organization
Organization Name:ATHENS RETINA CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:NARAYANASWAMY
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-543-3200
Mailing Address - Street 1:2705 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1208
Mailing Address - Country:US
Mailing Address - Phone:706-543-3200
Mailing Address - Fax:706-433-1745
Practice Address - Street 1:2705 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1208
Practice Address - Country:US
Practice Address - Phone:706-543-3200
Practice Address - Fax:706-433-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059245207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059245OtherSTATE LICENSE
GA73361OtherSTATE LICENSE
GAGRP8089Medicare PIN