NPIMap

Organization Active NPI

Carrollton Eye Clinic, P.C.

  • Ophthalmologic Surgery Clinic/Center
  • Carrollton, GA
National Provider Identifier
1447264247
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X
License
022-106 Issued in GA
Legal business name
CARROLLTON EYE CLINIC, P.C.
Practice address
158 Clinic Ave
Carrollton, GA 30117-4414
Phone
(770) 834-1008
Fax
(770) 834-2531
NPI assigned
Jul 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Authorized official

Name
Mrs. Angie Bradley
Title
Administrator
Phone
(770) 834-1008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmologic Surgery Clinic/Center 261QS0132X 022-106 GA Primary

Addresses

Primary practice location

158 Clinic Ave
Carrollton, GA 30117-4414

Mailing address

158 Clinic Ave
Carrollton, GA 30117-4414
Phone (770) 834-1008

Other identifiers 1

IdentifierTypeStateIssuer
000708804AMedicaidGA

Other names 1

  • CARROLLTON EYE CLINIC and SURGERY CENTER Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1447264247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 CLINIC AVE",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174414",
            "telephone_number": "770-834-1008",
            "fax_number": "770-834-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 CLINIC AVE",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174414",
            "telephone_number": "770-834-1008",
            "fax_number": "770-834-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLLTON EYE CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-834-1008",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": "GA",
            "license": "022-106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000708804A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARROLLTON EYE CLINIC and SURGERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.