Healthcare Provider Details

I. General information

NPI: 1598972069
Provider Name (Legal Business Name): ATLANTA VISION CATARACT & LASER CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 S FULTON AVE
HAPEVILLE GA
30354-1710
US

IV. Provider business mailing address

3619 S FULTON AVE
HAPEVILLE GA
30354-1710
US

V. Phone/Fax

Practice location:
  • Phone: 404-765-2020
  • Fax: 404-765-3884
Mailing address:
  • Phone: 404-765-2020
  • Fax: 404-765-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOPT001307
License Number StateGA

VIII. Authorized Official

Name: KAREN VANLANINGHAM
Title or Position: BILLING MANAGER
Credential:
Phone: 770-364-8186