NPIMap

Organization Active NPI

Marietta Eye Clinic, PA

  • Ophthalmology Physician
  • Marietta, GA
National Provider Identifier
1447469507
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MARIETTA EYE CLINIC, PA
Practice address
895 Canton Rd NE
Building 100
Marietta, GA 30060-8934
Phone
(770) 427-8111
NPI assigned
May 22, 2007
Last updated
May 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
Henry Elliott Gatehouse
Title
Senior Director
Phone
(770) 427-8111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

895 Canton Rd NE
Building 100
Marietta, GA 30060-8934

Mailing address

PO Box 63263
Charlotte, NC 28263-3263
Phone (770) 427-8111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040518000057 GA Part B Supplier - Clinic/Group Practice 0143210427 Receives reassigned benefits from 46 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Woodstock, GA; Villa Rica, GA; Suwanee, GA; Roswell, GA; Marietta, GA; Acworth, GA; Canton, GA; Cartersville, GA…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Paul Mitchell MD17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

4450 Calibre Xing NW
Ste 1104
Acworth, GA 30101
Phone (678) 279-1141

399 Market Place Blvd
Ste 100
Cartersville, GA 30121
Phone (678) 439-2490

8841 Hospital Dr
Douglasville, GA 30134
Phone (770) 577-2200

47 Highland Pavilion Ct
Hiram, GA 30141
Phone (770) 439-6997

1950 Spectrum Cir SE
Ste 150
Marietta, GA 30067
Phone (770) 952-6851

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1447469507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63263",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633263",
            "telephone_number": "770-427-8111",
            "fax_number": "770-499-1643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 CANTON RD NE",
            "address_2": "BUILDING 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608934",
            "telephone_number": "770-427-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA EYE CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "GATEHOUSE",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "SENIOR DIRECTOR",
        "authorized_official_telephone_number": "770-427-8111"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.