| Leiv M Takle Md Pc | |
|
646 S 8th St, Griffin, GA 30224-4214 | |
| (770) 228-3836 | |
| (770) 412-1733 |
| Full Name | Leiv M Takle Md Pc |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 646 S 8th St, Griffin, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568665404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | Leiv M Takle |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1609807445 PECOS PAC ID: 7719990134 Enrollment ID: I20060801000022 |
| Provider Name | Ruchi Parimal Gandhi |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1306214655 PECOS PAC ID: 3173827524 Enrollment ID: I20160802002917 |
| Provider Name | Andrew Coggin |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1518307081 PECOS PAC ID: 7719372960 Enrollment ID: I20220324002423 |
| Provider Name | Amit Bajaj |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1144783143 PECOS PAC ID: 6204294739 Enrollment ID: I20240731002706 |
| Provider Name | Vladislav Ivanchenko |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1497210009 PECOS PAC ID: 4385175926 Enrollment ID: I20241007001711 |
| Mailing Address | Practice Location Address |
|---|---|
| Leiv M Takle Md Pc 646 S 8th St, Griffin, GA 30224-4214 Ph: (770) 228-3836 | Leiv M Takle Md Pc 646 S 8th St, Griffin, GA 30224-4214 Ph: (770) 228-3836 |