Provider Demographics
NPI:1417019415
Name:ATLANTA EYE CONSULTANTS
Entity Type:Organization
Organization Name:ATLANTA EYE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JETTIE
Authorized Official - Middle Name:MARITA
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-0700
Mailing Address - Street 1:6170 OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4367
Mailing Address - Country:US
Mailing Address - Phone:770-996-0700
Mailing Address - Fax:770-996-1472
Practice Address - Street 1:6170 OLD NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-4367
Practice Address - Country:US
Practice Address - Phone:770-996-0700
Practice Address - Fax:770-996-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP566Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER