Provider Demographics
NPI:1609445600
Name:B3 MEDICAL LLC
Entity Type:Organization
Organization Name:B3 MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-415-8902
Mailing Address - Street 1:550 EAGLES LANDING PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9082
Mailing Address - Country:US
Mailing Address - Phone:770-415-8902
Mailing Address - Fax:
Practice Address - Street 1:1030 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2240
Practice Address - Country:US
Practice Address - Phone:706-327-3937
Practice Address - Fax:706-596-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty