Provider Demographics
NPI:1427337120
Name:KOW, JEREMY S (OD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:S
Last Name:KOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1757 E WEST CONNECTOR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1251
Mailing Address - Country:US
Mailing Address - Phone:770-941-2220
Mailing Address - Fax:770-941-4445
Practice Address - Street 1:1757 E WEST CONNECTOR
Practice Address - Street 2:SUITE 400
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1251
Practice Address - Country:US
Practice Address - Phone:770-941-2220
Practice Address - Fax:770-941-4445
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT002648OtherLICENSE NUMBER