Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2829 | TN |
Y | 152W00000X | Optometrist | OPT002479 | GA |
NPI | 1013172238 |
---|---|
Provider Name | Marc Sacha Helmy |
First Address | Austell, GA 30106-1100 |
Second Address | Austell, GA 30106-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 09/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
788583561A | (05) | GA |
788583561B | (05) | GA |
788583561C | (05) | GA |