Provider Demographics
NPI:1598972069
Name:ATLANTA VISION CATARACT & LASER CENTER PC
Entity Type:Organization
Organization Name:ATLANTA VISION CATARACT & LASER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLANINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-364-8186
Mailing Address - Street 1:3619 S FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1710
Mailing Address - Country:US
Mailing Address - Phone:404-765-2020
Mailing Address - Fax:404-765-3884
Practice Address - Street 1:3619 S FULTON AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1710
Practice Address - Country:US
Practice Address - Phone:404-765-2020
Practice Address - Fax:404-765-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001307207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7070Medicare PIN