Organization
SOUTHEAST RETINA CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BECKER (CFO)
(470) 243-2259
Entity
Organization
Contact information
Practice address
3685 WHEELER RD, STE 201, AUGUSTA, GA 30909-6440
(706) 650-0061
(706) 650-0064
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575
(864) 359-1308
(239) 496-3939
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000293719A
—
GA
05
—
000605283B
—
GA
05
—
GPA 668
—
SC
Enumeration date
12/14/2005
Last updated
04/28/2026
Update your record
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