Provider Demographics
NPI:1366580896
Name:GEORGIA EYE PHYSICIANS AND SURGEONS PC
Entity type:Organization
Organization Name:GEORGIA EYE PHYSICIANS AND SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-584-0400
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:STE 170
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:678-584-0400
Mailing Address - Fax:678-584-0568
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:STE 170
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:678-584-0400
Practice Address - Fax:678-584-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7130Medicare ID - Type Unspecified
GA5536100001Medicare NSC