Provider Demographics
NPI:1760243943
Name:HILBURG, AVIVA (LDO, ABOC, NCLEC)
Entity Type:Individual
Prefix:MS
First Name:AVIVA
Middle Name:
Last Name:HILBURG
Suffix:
Gender:F
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HOLLY SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9079
Mailing Address - Country:US
Mailing Address - Phone:770-213-6526
Mailing Address - Fax:770-345-9127
Practice Address - Street 1:2200 HOLLY SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-9079
Practice Address - Country:US
Practice Address - Phone:770-213-6526
Practice Address - Fax:770-345-9127
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002886156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician