Provider Demographics
NPI:1417647801
Name:ATKINS, LANARD (LDO, ABOC, NCLEC)
Entity type:Individual
Prefix:
First Name:LANARD
Middle Name:
Last Name:ATKINS
Suffix:
Gender:M
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:LC
Other - Middle Name:
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDO, ABOC, NCLEC
Mailing Address - Street 1:235 PONCE DE LEON PL # M-120
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3258
Mailing Address - Country:US
Mailing Address - Phone:404-839-7179
Mailing Address - Fax:
Practice Address - Street 1:235 PONCE DE LEON PL # M-120
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3258
Practice Address - Country:US
Practice Address - Phone:404-839-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2398156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty