Provider Demographics
NPI:1396084141
Name:AYRES, JULIAN ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ALEXANDER
Last Name:AYRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX P
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30562-0913
Mailing Address - Country:US
Mailing Address - Phone:404-983-4462
Mailing Address - Fax:
Practice Address - Street 1:PO BOX P
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:GA
Practice Address - Zip Code:30562-0913
Practice Address - Country:US
Practice Address - Phone:404-983-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 17770207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAA7247895OtherDRUG ENFORCEMENT AGENCY
HIAA7247895OtherDRUG ENFORCEMENT AGENCY