Provider Demographics
NPI:1457476731
Name:MARMER MEDICAL EYE CENTER PC-DBA ATLANTA FASHION OPTICAL
Entity Type:Organization
Organization Name:MARMER MEDICAL EYE CENTER PC-DBA ATLANTA FASHION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-768-2020
Mailing Address - Street 1:777 CLEVELAND AVE SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7129
Mailing Address - Country:US
Mailing Address - Phone:404-768-2020
Mailing Address - Fax:404-762-0087
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-768-2020
Practice Address - Fax:404-762-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00089086AMedicaid
GA0677270003Medicare NSC
GAD30147Medicare UPIN
GA00089086AMedicaid