Provider Demographics
NPI:1902169345
Name:SOUTHEAST EYE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:SOUTHEAST EYE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:GILPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-804-1684
Mailing Address - Street 1:800 MT VERNON HWY NE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:770-255-1275
Practice Address - Street 1:800 MT VERNON HWY NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-804-1684
Practice Address - Fax:770-255-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty