Provider Demographics
NPI:1659673218
Name:GEORGIA CENTER FOR SIGHT
Entity Type:Organization
Organization Name:GEORGIA CENTER FOR SIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-546-9290
Mailing Address - Street 1:651 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1250
Mailing Address - Country:US
Mailing Address - Phone:706-546-9290
Mailing Address - Fax:706-546-4938
Practice Address - Street 1:1110 COMMERCE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-7444
Practice Address - Country:US
Practice Address - Phone:706-453-1922
Practice Address - Fax:706-546-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045447332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000791568GMedicaid
GA18BDGNHMedicare PIN