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
Fax: (229) 255-2929
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376539445 NPPES
Georgia MEDICAID 003105037A

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