Organization
FAYETTE MEDICAL CLINIC OPTICAL SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICK RODECKER (ADMINISTRATOR)
(404) 351-2220
Entity
Organization
Contact information
Practice address
101 YORKTOWN DR STE 225, FAYETTEVILLE, GA 30214-1568
(770) 460-2331
(770) 460-4016
Mailing address
101 YORKTOWN DR STE 225, FAYETTEVILLE, GA 30214-1568
(770) 460-2331
(770) 460-4016
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20001558
GA
Other
Enumeration date
04/16/2007
Last updated
06/03/2021
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