| |
484 Moreland Ave Ne, D Ste, Atlanta, GA 30307 | |
(404) 523-3937 | |
(404) 688-3232 |
Full Name | |
---|---|
Type | Facility |
Speciality | Health Maintenance Organization |
Location | 484 Moreland Ave Ne, Atlanta, Georgia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619409729 | NPI | - | NPPES |
1619409729 | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | GA002600 (Georgia) | Secondary |
302R00000X | Health Maintenance Organization | 002600 (Georgia) | Primary |
Mailing Address | Practice Location Address |
---|---|
484 Moreland Ave Ne Ste D, Atlanta, GA 30307-3421 Ph: (404) 523-3937 | 484 Moreland Ave Ne, D Ste, Atlanta, GA 30307 Ph: (404) 523-3937 |