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General NPI Number Information
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NPI Number | 1871987404
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Entity Type | Organization
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Legal Business Name | VIVID VISION II
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 4066 PERCHERON LN
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City | SNELLVILLE
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State | GA
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Zip | 30039-2780
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Country | US
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Telephone | 404-202-5219
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Fax | 770-648-6289
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Provider Business Mailing Address
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Address Line | 4066 PERCHERON LN
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City | SNELLVILLE
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State | GA
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Zip | 30039-2780
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Country | US
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Telephone | 404-202-5219
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Fax | 770-648-6289
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHARI BLAKE
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Credential |
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Telephone | 404-202-5219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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