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
100 OLD BALL GROUND HWY, CANTON, GA 30114
(770) 479-2195
Mailing address
895 CANTON RD NE, BUILDING 100, MARIETTA, GA 30060-8934
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
12/14/2006
Last updated
05/15/2018
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