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Organization

EAST ATLANTA EYE SURGERY CENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARGARET WELBORN RN (NURSE MANAGER)
(470) 410-8120
Entity
Organization

Contact information

Practice address
550 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046-7686
(470) 410-8120
Mailing address
550 PROFESSIONAL DR, LAWRENCEVILLE, GA 30046-7686
(470) 410-8120

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
067-377
GEORGIA STATE FACILITY LICENSE
GA
Enumeration date
03/23/2020
Last updated
04/06/2021
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