Organization
UPSON EYE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE N BRADLEY (BILLING)
(706) 647-8138
Entity
Organization
Contact information
Practice address
232 CHEROKEE RD, THOMASTON, GA 30286-3402
(706) 647-8138
(706) 647-8745
Mailing address
232 CHEROKEE RD, THOMASTON, GA 30286-3402
(706) 647-8138
(706) 647-8745
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
048999
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000896695A
—
GA
01
—
CB6575
RAILROAD MEDICARE
GA
Enumeration date
11/21/2007
Last updated
05/07/2009
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