Provider Demographics
NPI:1871716654
Name:BEHRENS, JAMES EDWIN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWIN
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3460 KINGSBORO RD NE
Mailing Address - Street 2:840
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3300
Mailing Address - Country:US
Mailing Address - Phone:404-812-0780
Mailing Address - Fax:
Practice Address - Street 1:350 FERST DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-0001
Practice Address - Country:US
Practice Address - Phone:404-894-9533
Practice Address - Fax:404-894-2026
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001904152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy