Organization
MARIETTA EYE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY ELLIOTT GATEHOUSE (SENIOR DIRECTOR)
(770) 427-8111
Entity
Organization
Contact information
Practice address
2990 EAGLE DR STE 110, WOODSTOCK, GA 30189
(770) 427-8111
Mailing address
895 CANTON RD NE BLDG 100, MARIETTA, GA 30060-8935
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
07/06/2017
Last updated
05/15/2018
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