Georgia Eye Institute of the Southeast, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC

Practice address

6162 Hwy 21 South
Rincon, GA 31326-5164

Phone

(912) 826-3949

Fax

(912) 826-0389

NPI assigned

Nov 5, 2008

Last updated

Oct 17, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kathy Hegan

Title

Practice Administrator

Phone

(912) 629-5929

Specialties & licenses 2

Addresses

Other identifiers 2

Part of

Georgia Eye Institute of the Southeast LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1144474016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 WATERS AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046292",
            "telephone_number": "912-354-4800",
            "fax_number": "912-629-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6162 HWY 21 SOUTH",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265164",
            "telephone_number": "912-826-3949",
            "fax_number": "912-826-0389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC",
        "enumeration_date": "2008-11-05",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEGAN",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "912-629-5929",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID MD",
            "identifier": "GPA977",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OD",
            "identifier": "DAG976",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Fuqua, MSW
• Laura Gash
• Sarai M George
• Georgia CVS Pharmacy LLC (CVS Pharmacy # 07758)
• Georgia Emergency Associates
• Georgia Eye Institute, Inc.
• Teneka Nadia Gerido, LPC
• James R Gill, M.D.
• Kristal Gill, PMHNP-BC
• Janneska Godoy

• Optometrist in Rincon, GA
• Providers in Rincon, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.