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
895 CANTON RD NE, BUILDING 100, MARIETTA, GA 30060-8934
(770) 427-8111
Mailing address
PO BOX 63263, CHARLOTTE, NC 28263-3263
(770) 427-8111
(770) 499-1643
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
05/22/2007
Last updated
05/17/2018
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