MEDICARE: VISIONSOUTH PC

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	207W00000X	Ophthalmology Physician	15436	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720350788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONSOUTH PC

Provider Business Mailing Address
First Line	:	2700 HIGHWAY 280 S
Second Line	:	SUITE 212
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2420
Country	:	US
Telephone Number	:	205-879-2221
Fax Number	:	205-879-0615

Provider Business Practice Location Address
First Line	:	2700 HIGHWAY 280 S
Second Line	:	SUITE 212
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2420
Country	:	US
Telephone Number	:	205-879-2221
Fax Number	:	205-879-0615

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. CHARLES MICHAEL ADAMS
Credential	:	M.D.
Telephone Number	:	205-879-2221

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	02/06/2012

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Directions to “VISIONSOUTH PC ” Practice Location

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