Provider Demographics
NPI:1457683914
Name:ATHENS EYE SURGERY CENTER,LLC
Entity Type:Organization
Organization Name:ATHENS EYE SURGERY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-9993
Mailing Address - Street 1:105 TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-2112
Mailing Address - Country:US
Mailing Address - Phone:706-549-9993
Mailing Address - Fax:706-286-7045
Practice Address - Street 1:105 TRINITY PL
Practice Address - Street 2:STE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-2112
Practice Address - Country:US
Practice Address - Phone:706-549-9993
Practice Address - Fax:706-286-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11C0001357Medicare Oscar/Certification