Provider Demographics
NPI:1417260142
Name:BIRDSONG EYE CARE LLC
Entity Type:Organization
Organization Name:BIRDSONG EYE CARE LLC
Other - Org Name:DBA BROOKWOOD EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRDSONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-736-7774
Mailing Address - Street 1:850 DOGWOOD RD
Mailing Address - Street 2:SUITE A-300
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7218
Mailing Address - Country:US
Mailing Address - Phone:770-736-7774
Mailing Address - Fax:
Practice Address - Street 1:850 DOGWOOD RD
Practice Address - Street 2:SUITE A-300
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7218
Practice Address - Country:US
Practice Address - Phone:770-736-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002535302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization