Organization
GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Active
Parent organization
GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Authorized official
MRS. KATHY HEGAN (PRACTICE ADMINISTRATOR)
(912) 629-5929
Entity
Organization
Contact information
Practice address
300 DURDEN ST, VIDALIA, GA 30474-4606
(912) 537-4447
(912) 537-2743
Mailing address
4720 WATERS AVE, SAVANNAH, GA 31404-6292
(912) 354-4800
(912) 629-5821
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DAG976
MEDICAID OD
SC
01
—
GPA977
MEDICAID MD
SC
Enumeration date
11/05/2008
Last updated
10/10/2012
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