Provider Demographics
NPI:1568513489
Name:NORTH GEORGIA EYE CARE LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:FAMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:706-340-2781
Mailing Address - Street 1:72 W CANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2557
Mailing Address - Country:US
Mailing Address - Phone:770-867-1913
Mailing Address - Fax:770-867-2359
Practice Address - Street 1:72 W CANDLER ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2557
Practice Address - Country:US
Practice Address - Phone:770-867-1913
Practice Address - Fax:770-867-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001728156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5995850001Medicare NSC