Provider Demographics
NPI:1508889601
Name:GAYTON HEALTH CENTRE
Entity Type:Organization
Organization Name:GAYTON HEALTH CENTRE
Other - Org Name:EYESIGHT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING REP
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-929-6272
Mailing Address - Street 1:216 CORDER RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3604
Mailing Address - Country:US
Mailing Address - Phone:478-923-5872
Mailing Address - Fax:478-922-9020
Practice Address - Street 1:1011 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-273-0435
Practice Address - Fax:229-273-4665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAYTON HEALTH CENTRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 4811Medicare NSC
GA4686410003Medicare NSC