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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
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