Provider Demographics
NPI:1700078243
Name:CHEROKEE EYE GROUP, INC
Entity Type:Organization
Organization Name:CHEROKEE EYE GROUP, INC
Other - Org Name:DAWSON EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
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 1:5983 HIGHWAY 53 E
Mailing Address - Street 2:HIGHTOWER PLACE STE. 250
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-9513
Mailing Address - Country:US
Mailing Address - Phone:706-216-6595
Mailing Address - Fax:706-216-6594
Practice Address - Street 1:5983 HIGHWAY 53 E
Practice Address - Street 2:HIGHTOWER PLACE STE. 250
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-9513
Practice Address - Country:US
Practice Address - Phone:706-216-6595
Practice Address - Fax:706-216-6594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHEROKEE EYE GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
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
GA0835600003Medicare NSC