Organization
SOUTHERN EYE ASSOCIATES OF GA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTUS STEPHENS MD (OWNER)
(404) 265-2020
Entity
Organization
Contact information
Practice address
340 BOULEVARD NE, SUITE 318, ATLANTA, GA 30312-1273
(404) 265-2020
Mailing address
340 BOULEVARD NE, SUITE 318, ATLANTA, GA 30312-1273
(404) 265-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00093221C
PEACHSTATE
GA
01
—
1003900
AMERIGROUP
GA
01
—
180046095
MEDICARE RAILROAD
GA
01
—
182460432823
HUMANA
GA
01
—
309318
WELLCARE
GA
Enumeration date
11/09/2007
Last updated
05/06/2008
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