Provider Demographics
NPI:1902870751
Name:DOUGLASVILLE EYE CLINIC PC
Entity Type:Organization
Organization Name:DOUGLASVILLE EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-838-9999
Mailing Address - Street 1:6001 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 2040
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5632
Mailing Address - Country:US
Mailing Address - Phone:678-838-9999
Mailing Address - Fax:678-838-9474
Practice Address - Street 1:6001 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 2040
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5632
Practice Address - Country:US
Practice Address - Phone:678-838-9999
Practice Address - Fax:678-838-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0606334207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA481887156AMedicaid
GADD6182OtherRAILROAD MEDICARE
GA5540960001Medicare NSC
GADD6182OtherRAILROAD MEDICARE