Provider Demographics
NPI:1679996425
Name:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC.
Entity type:Organization
Organization Name:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-5929
Mailing Address - Street 1:4720 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6292
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:
Practice Address - Street 1:605 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-1775
Practice Address - Country:US
Practice Address - Phone:912-654-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA EYE INSTITUTE OF THE SOUTHEAST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-30
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty