Provider Demographics
NPI:1548499361
Name:MAYA FAMILY INC
Entity type:Organization
Organization Name:MAYA FAMILY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MPH
Authorized Official - Phone:404-853-5008
Mailing Address - Street 1:860 PEACHTREE ST NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1249
Mailing Address - Country:US
Mailing Address - Phone:404-853-5008
Mailing Address - Fax:404-853-5009
Practice Address - Street 1:860 PEACHTREE ST NE
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1249
Practice Address - Country:US
Practice Address - Phone:404-853-5008
Practice Address - Fax:404-853-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty