Organization
JUMPSTART FITNESS INC
Active
Other names
Ellijay Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
MELONIE CLEMMONS O.D. (PRESIDENT)
(706) 276-2000
Entity
Organization
Contact information
Practice address
60 OLD HIGHWAY 5 S, ELLIJAY, GA 30540-5436
(170) 627-6200
(706) 276-2080
Mailing address
PO BOX 146, EAST ELLIJAY, GA 30539-0003
(706) 276-2000
(706) 276-2080
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001550
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910061011A
—
GA
Enumeration date
04/10/2007
Last updated
08/24/2021
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