Organization
ATLANTA EYE INTERNATIONAL SURGERY CENTER INC.
Active
Parent organization
ATLANTA EYE CONSULTANT
Organization subpart
Yes
Provider details
NPI number
Legal business name
ATLANTA EYE CONSULTANT
Authorized official
DR. SHELBY RAY WILKES M.D. (MEDICAL DIRECTOR)
(404) 881-6417
Entity
Organization
Contact information
Practice address
830 W PEACHTREE ST NW, SUITE 101, ATLANTA, GA 30308-1129
(404) 881-6417
(404) 876-7565
Mailing address
830 W PEACHTREE ST NW, SUITE 101, ATLANTA, GA 30308-1129
(404) 881-6417
(404) 876-7565
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
11-C0001213
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001796
BLUE CROSS BLUE SHIELD
GA
05
—
681158897A
—
GA
01
—
P00067521
RAILROAD MEDICARE
GA
Enumeration date
07/22/2006
Last updated
06/21/2012
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