1740946250 NPI number — THOMAS EYE GROUP PC

Table of content: (NPI 1740946250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740946250 NPI number — THOMAS EYE GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS EYE GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THOMAS EYE GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740946250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 PEACHTREE DUNWOODY RD STE A500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-7162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5295 STONE MOUNTAIN HWY STE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONE MOUNTAIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30087-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-879-1961
Provider Business Practice Location Address Fax Number:
770-879-9872
Provider Enumeration Date:
11/10/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KAUFMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
678-892-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)