Provider Demographics
NPI:1689738817
Name:KENT ALAN VOYCE OD PC
Entity Type:Organization
Organization Name:KENT ALAN VOYCE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR'S ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TABBATHA
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-502-1891
Mailing Address - Street 1:1025 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6803
Mailing Address - Country:US
Mailing Address - Phone:770-502-1891
Mailing Address - Fax:770-502-1924
Practice Address - Street 1:1025 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6803
Practice Address - Country:US
Practice Address - Phone:770-502-1891
Practice Address - Fax:770-502-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000618769CMedicaid
GA410034736OtherRAIL ROAD MEDICARE
GA=========OtherTAX ID
GA410034736OtherRAIL ROAD MEDICARE
GA=========OtherTAX ID
GAU18351Medicare UPIN
GAGRP2929Medicare PIN