Provider Demographics
NPI:1912183708
Name:JEANNE M PERRINE OD PC
Entity Type:Organization
Organization Name:JEANNE M PERRINE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-589-8517
Mailing Address - Street 1:501 PULLIAM ST SW
Mailing Address - Street 2:STE139
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2755
Mailing Address - Country:US
Mailing Address - Phone:404-589-8517
Mailing Address - Fax:404-222-0174
Practice Address - Street 1:501 PULLIAM ST SW
Practice Address - Street 2:STE139
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2755
Practice Address - Country:US
Practice Address - Phone:404-589-8517
Practice Address - Fax:404-222-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty