Healthcare Provider Details

I. General information

NPI: 1346947637
Provider Name (Legal Business Name): VISION IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 EAST PINETREE BOULEVARD
THOMASVILLE GA
31792
US

IV. Provider business mailing address

2544 EAST PINETREE BOULEVARD
THOMASVILLE GA
31792
US

V. Phone/Fax

Practice location:
  • Phone: 229-516-1411
  • Fax:
Mailing address:
  • Phone: 229-516-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDI WEAVER WARREN
Title or Position: OWNER
Credential: DO
Phone: 229-594-6800