Organization
TAKLE EYE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEIV M TAKLE JR. MD (OWNER)
(770) 228-3836
Entity
Organization
Contact information
Practice address
1075 BANDY PKWY, STE 105, LOCUST GROVE, GA 30248
(770) 228-3836
Mailing address
1075 BANDY PKWY STE 105, LOCUST GROVE, GA 30248-7036
(770) 282-3590
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
07/05/2018
Last updated
07/19/2021
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