Basic Information
| Provider Information | |||||||||
| NPI: | 1831381243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IGBRE | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | O. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT RD NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043647070 | ||||||||
| FaxNumber: | 4103397326 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 STEVE REYNOLDS BLVD | ||||||||
| Address2: | KAISER PERMANENTE GWINNETT MEDICAL CENTER | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103374500 | ||||||||
| FaxNumber: | 4103397326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 0101249433 | VA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | D72164 | MD | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | C7-0004368 | DE | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MT190630 | PA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 070301 | GA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 043399300 | 05 | MD | MEDICAID |