Basic Information
| Provider Information | |||||||||
| NPI: | 1609445600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | B3 MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 EAGLES LANDING PKWY STE 208 | ||||||||
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| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302819082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704158902 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 13TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319012240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063273937 | ||||||||
| FaxNumber: | 7065966658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2021 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | DEPOE | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7704158902 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.