Provider Demographics
NPI:1013196377
Name:SUZANNE KIMMONS, OD, PC
Entity Type:Organization
Organization Name:SUZANNE KIMMONS, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMONS-DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-216-7732
Mailing Address - Street 1:6628 HIGHWAY 53 E
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6806
Mailing Address - Country:US
Mailing Address - Phone:706-216-7732
Mailing Address - Fax:706-216-7733
Practice Address - Street 1:6628 HIGHWAY 53 E
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6806
Practice Address - Country:US
Practice Address - Phone:706-216-7732
Practice Address - Fax:706-216-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAT1164332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4825OtherMEDICARE GROUP
GAGRP4825OtherMEDICARE GROUP