Provider Demographics
NPI:1114696549
Name:HIS VISION HEALTHCARE
Entity Type:Organization
Organization Name:HIS VISION HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-437-9419
Mailing Address - Street 1:4153C FLAT SHOALS PKWY STE E4153C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4858
Mailing Address - Country:US
Mailing Address - Phone:404-437-9419
Mailing Address - Fax:
Practice Address - Street 1:4153C FLAT SHOALS PKWY STE E4153C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4858
Practice Address - Country:US
Practice Address - Phone:470-558-8761
Practice Address - Fax:770-727-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health