Provider Demographics
NPI:1548384738
Name:ATLANTA OPHTHALMOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ATLANTA OPHTHALMOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-252-1194
Mailing Address - Street 1:993 D JOHNSON FERRY RD SUITE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-1194
Mailing Address - Fax:404-252-3150
Practice Address - Street 1:993 D JOHNSON FERRY RD SUITE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-1194
Practice Address - Fax:404-252-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA030728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1017150001Medicare NSC
GAGRP3414Medicare PIN