Provider Demographics
NPI:1477831360
Name:GEORGIA OPHTHALMOLOGISTS LLC
Entity Type:Organization
Organization Name:GEORGIA OPHTHALMOLOGISTS LLC
Other - Org Name:GEORGIA OPHTHALMOLOGISTS AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-786-1234
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-7898
Mailing Address - Country:US
Mailing Address - Phone:770-786-1234
Mailing Address - Fax:678-712-6977
Practice Address - Street 1:4159 MILL ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2546
Practice Address - Country:US
Practice Address - Phone:770-786-1234
Practice Address - Fax:678-712-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107-075261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical