Organization
OPTICAL ASSOCIATES OF SOUTH GA LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFFORD D COURTENAY O.D. (CEO)
(229) 247-4114
Entity
Organization
Contact information
Practice address
3024 N PATTERSON ST, VALDOSTA, GA 31602-1711
(229) 247-0447
Mailing address
3024 N PATTERSON ST, VALDOSTA, GA 31602-1711
(229) 247-4114
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001045
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000317138J
—
GA
Enumeration date
05/18/2007
Last updated
09/09/2013
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