Provider Demographics
NPI:1710521430
Name:HIS VISION HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:HIS VISION HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OVERSEER
Authorized Official - Prefix:MS
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 330 D-F
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4863
Mailing Address - Country:US
Mailing Address - Phone:470-558-8461
Mailing Address - Fax:404-393-1125
Practice Address - Street 1:4153C FLAT SHOALS PKWY STE 330 D-F
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4863
Practice Address - Country:US
Practice Address - Phone:470-558-8861
Practice Address - Fax:404-393-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health