Provider Demographics
NPI:1417915539
Name:KURTH, AMY LEIGHANN (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGHANN
Last Name:KURTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2801
Mailing Address - Country:US
Mailing Address - Phone:770-479-4481
Mailing Address - Fax:770-479-8932
Practice Address - Street 1:591 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2801
Practice Address - Country:US
Practice Address - Phone:770-479-4481
Practice Address - Fax:770-479-8932
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000958559AMedicaid
GA41ZCFBRMedicare ID - Type UnspecifiedOPTOMETRIST
GA000958559AMedicaid