Individual
DR. JERRY M OVERALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
208 SMITH ST, LAGRANGE, GA 30240-2755
(706) 882-0166
(706) 883-7363
Mailing address
208 SMITH ST, LAGRANGE, GA 30240-2755
(706) 882-0166
(706) 883-7363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT000678
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00004496A
—
GA
Enumeration date
04/27/2006
Last updated
10/31/2007
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