Provider Demographics
NPI:1851515225
Name:KEESHA K HAMPTON OD PC
Entity Type:Organization
Organization Name:KEESHA K HAMPTON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-445-3938
Mailing Address - Street 1:935 QUEENSBROOKE WAY
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-6413
Mailing Address - Country:US
Mailing Address - Phone:770-445-3938
Mailing Address - Fax:770-445-0127
Practice Address - Street 1:3615 CHARLES HARDY PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9472
Practice Address - Country:US
Practice Address - Phone:770-445-3938
Practice Address - Fax:770-445-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAOPT002236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty