Provider Demographics
NPI:1265748222
Name:DEPOE MANAGEMENT, LLC
Entity type:Organization
Organization Name:DEPOE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEPOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-474-1237
Mailing Address - Street 1:550 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9081
Mailing Address - Country:US
Mailing Address - Phone:770-474-1237
Mailing Address - Fax:770-474-5224
Practice Address - Street 1:550 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9081
Practice Address - Country:US
Practice Address - Phone:770-474-1237
Practice Address - Fax:770-474-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty