Atlanta Eye International Surgery Center Inc.

Key facts

NPI

1285655464

Entity type

Organization (NPI type 2)

Primary specialty

Ambulatory Surgical Clinic/Center 261QA1903X

License

11-C0001213 (GA)

Legal business name

ATLANTA EYE INTERNATIONAL SURGERY CENTER INC.

Practice address

830 W Peachtree St NW
Suite 101
Atlanta, GA 30308-1129

Phone

(404) 881-6417

Fax

(404) 876-7565

NPI assigned

Jul 22, 2006

Organization subpart

Yes

Parent organization (as reported)

ATLANTA EYE CONSULTANT

Authorized official

Name

Dr. Shelby Ray Wilkes, M.D.

Title

Medical Director

Phone

(404) 881-6417

National Provider Directory

Part of

Atlanta Eye Consultants PC

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 21, 2012.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1285655464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W PEACHTREE ST NW",
            "address_2": "SUITE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303081129",
            "telephone_number": "404-881-6417",
            "fax_number": "404-876-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 W PEACHTREE ST NW",
            "address_2": "SUITE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303081129",
            "telephone_number": "404-881-6417",
            "fax_number": "404-876-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA EYE INTERNATIONAL SURGERY CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLANTA EYE CONSULTANT",
        "enumeration_date": "2006-07-22",
        "last_updated": "2012-06-21",
        "status": "A",
        "authorized_official_last_name": "WILKES",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-881-6417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "11-C0001213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00067521",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001796",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "681158897A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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