Provider Demographics
NPI:1740338185
Name:ALLATOONA EYE INSTITUTE PC
Entity type:Organization
Organization Name:ALLATOONA EYE INSTITUTE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-382-3598
Mailing Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2154
Mailing Address - Country:US
Mailing Address - Phone:770-382-3598
Mailing Address - Fax:
Practice Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 201
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2154
Practice Address - Country:US
Practice Address - Phone:770-382-3598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0627860001Medicare NSC
GRP2134Medicare PIN