Provider Demographics
NPI:1386218915
Name:OPHTHALMOLOGY AND RETINA ASSOCIATES OF GEORGIA LLC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY AND RETINA ASSOCIATES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:SHARAD
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-777-2020
Mailing Address - Street 1:1579 MONROE DR NE STE F242
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5039
Mailing Address - Country:US
Mailing Address - Phone:404-777-2020
Mailing Address - Fax:404-777-7701
Practice Address - Street 1:5185 PEACHTREE PKWY STE 365
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-6542
Practice Address - Country:US
Practice Address - Phone:404-777-2020
Practice Address - Fax:404-777-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Multi-Specialty