Provider Demographics
NPI:1922176627
Name:CHEROKEE EYE GROUP, INC.
Entity Type:Organization
Organization Name:CHEROKEE EYE GROUP, INC.
Other - Org Name:CHEROKEE EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-479-4481
Mailing Address - Street 1:591 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2801
Mailing Address - Country:US
Mailing Address - Phone:770-479-4481
Mailing Address - Fax:770-479-8932
Practice Address - Street 1:591 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2801
Practice Address - Country:US
Practice Address - Phone:770-479-4481
Practice Address - Fax:770-479-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0835600001Medicare NSC