Provider Demographics
NPI:1740652148
Name:PTCEC PC
Entity type:Organization
Organization Name:PTCEC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PUNIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-487-8900
Mailing Address - Street 1:100 N PEACHTREE PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1744
Mailing Address - Country:US
Mailing Address - Phone:770-487-8900
Mailing Address - Fax:770-487-4118
Practice Address - Street 1:100 N PEACHTREE PKWY STE 1
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1744
Practice Address - Country:US
Practice Address - Phone:770-487-8900
Practice Address - Fax:770-487-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-24
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty