Organization
GEORGIA OPHTHALMOLOGY ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. P SANFORD (ADMINISTRATOR)
(404) 298-5557
Entity
Organization
Contact information
Practice address
465 WINN WAY, SUITE 140, DECATUR, GA 30030-1753
(404) 298-5557
(404) 297-9480
Mailing address
465 WINN WAY, SUITE 140, DECATUR, GA 30030-1753
(404) 298-5557
(404) 297-9480
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
017845
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP2817
MEDICARE - GROUP
GA
Enumeration date
02/28/2007
Last updated
11/26/2007
Update your record
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