MEDICARE: VISTA MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1447686738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	325 LESTER RD NW STE C
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 LESTER RD NW STE C
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4046
Country	:	US
Telephone Number	:	770-935-1515
Fax Number	:

Authorized Official
Title or Position	:	M.D
Name	:	AFROZ RAHMAN
Credential	:
Telephone Number	:	770-935-1515

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	02/05/2021

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Directions to “VISTA MEDICAL CLINIC ” Practice Location

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