Provider Demographics
NPI:1609831338
Name:SOLOMON, GRIGORIY (OD)
Entity type:Individual
Prefix:DR
First Name:GRIGORIY
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 WATERFORD CV
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1332
Mailing Address - Country:US
Mailing Address - Phone:404-634-7210
Mailing Address - Fax:
Practice Address - Street 1:1781 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4072
Practice Address - Country:US
Practice Address - Phone:404-471-9990
Practice Address - Fax:404-471-9910
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002033152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000962662BMedicaid
GA41ZCFPGMedicare ID - Type Unspecified
GA000962662BMedicaid