Healthcare Provider Details

I. General information

NPI: 1295205979
Provider Name (Legal Business Name): MAJESTIC VISIONS ALLIANCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 COCHRAN MILL RD
FAIRBURN GA
30213-2121
US

IV. Provider business mailing address

4405 CASCADE PALMETTO HWY
FAIRBURN GA
30213-1852
US

V. Phone/Fax

Practice location:
  • Phone: 770-774-3230
  • Fax: 770-774-9782
Mailing address:
  • Phone: 770-306-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SWAN WILSON
Title or Position: CFO
Credential:
Phone: 562-755-1063