Ahlmark-Gordon, Renee Candace
Ahlmark-Gordon, Renee Candace is an individual health care provider with primary practice located at 1569 Us Highway 19 S , Leesburg GA 31763-4939. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Ahlmark-Gordon, Renee Candace can be contacted via phone (229) 439-1200.Contact Information
Primary practice address
1569 Us Highway 19 S
Leesburg GA 31763-4939
Phone: (229) 439-1200
Fax: (229) 255-2929
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPT002136 | Georgia |
Profile Details
| NPI number | 1376539445 |
|---|---|
| LBN Legal business name | Ahlmark-Gordon, Renee Candace |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 23rd, 2005 |
| Last updated | Mar 29th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376539445 | NPPES |
| Georgia | MEDICAID | 003105037A |
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