Organization
AMEDCO GEORGIA LLC
Active
Other names
Tifton Ophthalmology
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA PERREIRA (CHIEF OPERATING OFFICER)
(877) 881-0022
Entity
Organization
Contact information
Practice address
1803 OLD OCILLA RD, TIFTON, GA 31794-1617
(229) 986-2181
(229) 386-2193
Mailing address
8076 W SAHARA AVE, LAS VEGAS, NV 89117-7930
(877) 881-0022
(702) 543-0314
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0774710001
CIGNA - GA
GA
01
—
CC4435
RR MEDICARE
GA
01
—
GRP2612
MEDICARE
GA
Enumeration date
04/29/2013
Last updated
04/29/2013
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