Provider Demographics
NPI:1811094246
Name:HAMPTON, KEESHA K (OD)
Entity type:Individual
Prefix:
First Name:KEESHA
Middle Name:K
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KEESHA
Other - Middle Name:K
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, PC
Mailing Address - Street 1:935 QUEENSBROOKE WAY
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-6413
Mailing Address - Country:US
Mailing Address - Phone:678-945-4673
Mailing Address - Fax:
Practice Address - Street 1:3615 CHARLES HARDY PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9472
Practice Address - Country:US
Practice Address - Phone:770-445-3938
Practice Address - Fax:770-445-0127
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAOPT002236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCGKCMedicare PIN