Provider Demographics
NPI:1609171800
Name:SOUTH GEORGIA EYE PARTNERS, PC
Entity Type:Organization
Organization Name:SOUTH GEORGIA EYE PARTNERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-249-0944
Mailing Address - Street 1:340 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-7713
Mailing Address - Country:US
Mailing Address - Phone:229-249-0744
Mailing Address - Fax:229-391-4392
Practice Address - Street 1:340 NORMAN DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-7713
Practice Address - Country:US
Practice Address - Phone:229-249-0744
Practice Address - Fax:229-391-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty