Provider Demographics
NPI:1689298457
Name:NORTHEAST GEORGIA OPHTHALMOLOGY, LLC
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VANDANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-767-3937
Mailing Address - Street 1:195 14TH ST NE UNIT 805
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2673
Mailing Address - Country:US
Mailing Address - Phone:770-596-8605
Mailing Address - Fax:713-903-7907
Practice Address - Street 1:1498 JESSE JEWELL PKWY SE STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3874
Practice Address - Country:US
Practice Address - Phone:770-596-8605
Practice Address - Fax:713-903-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery