Provider Demographics
NPI:1770679094
Name:EYE CONSULTANTS OF ATLANTA, PC
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF ATLANTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-2220
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-591-2939
Practice Address - Street 1:3225 CUMBERLAND BLVD SE
Practice Address - Street 2:SUITE 800 OR 900
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6407
Practice Address - Country:US
Practice Address - Phone:404-351-2220
Practice Address - Fax:404-591-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP965OtherMEDICARE ID
GAC30849Medicare PIN
GAGRP965OtherMEDICARE ID