Provider Demographics
NPI:1720602683
Name:GEORGIA EYE SURGERY LLC
Entity Type:Organization
Organization Name:GEORGIA EYE SURGERY LLC
Other - Org Name:GEORGIA EYE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CENTRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-546-0170
Mailing Address - Street 1:1620 PRINCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6008
Mailing Address - Country:US
Mailing Address - Phone:706-546-0170
Mailing Address - Fax:706-383-2166
Practice Address - Street 1:1620 PRINCE AVE STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6008
Practice Address - Country:US
Practice Address - Phone:706-546-0170
Practice Address - Fax:706-383-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical