Provider Demographics
NPI:1073814505
Name:CC VISIONS
Entity Type:Organization
Organization Name:CC VISIONS
Other - Org Name:CELETHIA COLEMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNA/PCT
Authorized Official - Prefix:MS
Authorized Official - First Name:CELETHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-823-4481
Mailing Address - Street 1:600 ADDISON WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8075
Mailing Address - Country:US
Mailing Address - Phone:404-823-4481
Mailing Address - Fax:678-782-3530
Practice Address - Street 1:600 ADDISON WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8075
Practice Address - Country:US
Practice Address - Phone:404-823-4481
Practice Address - Fax:678-782-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA812199302R00000X
GA12053036343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)