Organization
CARROLLTON EYE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGIE BRADLEY (ADMINISTRATOR)
(770) 834-1008
Entity
Organization
Contact information
Practice address
158 CLINIC AVE, CARROLLTON, GA 30117-4414
(770) 834-1008
(770) 834-2531
Mailing address
158 CLINIC AVE, CARROLLTON, GA 30117-4414
(770) 834-1008
(770) 834-2531
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300022259A
—
GA
Enumeration date
08/23/2006
Last updated
12/16/2009
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