Healthcare Provider Details

I. General information

NPI: 1073814505
Provider Name (Legal Business Name): CC VISIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ADDISON WAY
MCDONOUGH GA
30253-8075
US

IV. Provider business mailing address

600 ADDISON WAY
MCDONOUGH GA
30253-8075
US

V. Phone/Fax

Practice location:
  • Phone: 404-823-4481
  • Fax: 678-782-3530
Mailing address:
  • Phone: 404-823-4481
  • Fax: 678-782-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number812199
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number12053036
License Number StateGA

VIII. Authorized Official

Name: MS. CELETHIA J COLEMAN
Title or Position: CNA/PCT
Credential:
Phone: 404-823-4481