Provider Demographics
NPI:1851084933
Name:XPERIENCE DREVAGEE
Entity Type:Organization
Organization Name:XPERIENCE DREVAGEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-522-1093
Mailing Address - Street 1:2451 CUMBERLAND PKWY SE STE 3809
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:678-522-1093
Mailing Address - Fax:
Practice Address - Street 1:5745 WENDY BAGWELL PKWY STE 32
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2885
Practice Address - Country:US
Practice Address - Phone:678-522-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty