Provider Demographics
NPI:1104819903
Name:PERRINE, JEANNE MARIE (OD PC)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MARIE
Last Name:PERRINE
Suffix:
Gender:F
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PULLIAM ST SW
Mailing Address - Street 2:SUITE 139
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2755
Mailing Address - Country:US
Mailing Address - Phone:404-589-8517
Mailing Address - Fax:404-222-0174
Practice Address - Street 1:501 PULLIAM ST SW
Practice Address - Street 2:SUITE 139
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2755
Practice Address - Country:US
Practice Address - Phone:404-589-8517
Practice Address - Fax:404-222-0174
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-07-03
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-20
Provider Licenses
StateLicense IDTaxonomies
GAOPT001112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist