Provider Demographics
NPI:1811024045
Name:EAST GEORGIA EYECARE LLC
Entity Type:Organization
Organization Name:EAST GEORGIA EYECARE LLC
Other - Org Name:EAST GEORGIA EYECARE, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RCM SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-860-1919
Mailing Address - Street 1:1192 DOGWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-5454
Mailing Address - Country:US
Mailing Address - Phone:770-860-1919
Mailing Address - Fax:770-860-1607
Practice Address - Street 1:1192 DOGWOOD DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5454
Practice Address - Country:US
Practice Address - Phone:770-860-1919
Practice Address - Fax:770-860-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty