Provider Demographics
NPI:1851801286
Name:GEORGIA OPHTHALMOLOGISTS LLC
Entity Type:Organization
Organization Name:GEORGIA OPHTHALMOLOGISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-786-1234
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-7898
Mailing Address - Country:US
Mailing Address - Phone:770-786-1234
Mailing Address - Fax:678-712-6977
Practice Address - Street 1:1311 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1758
Practice Address - Country:US
Practice Address - Phone:770-267-7824
Practice Address - Fax:678-712-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002463152W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty