Provider Demographics
NPI:1689833089
Name:NW GEORGIA EYE CARE
Entity Type:Organization
Organization Name:NW GEORGIA EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, OD
Authorized Official - Phone:706-695-0107
Mailing Address - Street 1:2120 HIGHWAY 76
Mailing Address - Street 2:SUITE A COHUTTA PLACE
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-7302
Mailing Address - Country:US
Mailing Address - Phone:706-695-0107
Mailing Address - Fax:706-517-9633
Practice Address - Street 1:2120 HIGHWAY 76
Practice Address - Street 2:SUITE A COHUTTA PLACE
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-7302
Practice Address - Country:US
Practice Address - Phone:706-695-0107
Practice Address - Fax:706-517-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700552Medicare PIN
GAP00657038Medicare PIN