Provider Demographics
NPI:1184757312
Name:ADVANCED FAMILY EYECARE
Entity type:Organization
Organization Name:ADVANCED FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-614-8577
Mailing Address - Street 1:960 SCALES RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8437
Mailing Address - Country:US
Mailing Address - Phone:770-614-8577
Mailing Address - Fax:
Practice Address - Street 1:960 SCALES RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8437
Practice Address - Country:US
Practice Address - Phone:770-614-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA002162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty