Provider Demographics
NPI:1942770599
Name:MAJESTIC VISIONS ALLIANCES, INC.
Entity Type:Organization
Organization Name:MAJESTIC VISIONS ALLIANCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERVIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-748-8255
Mailing Address - Street 1:4405 CASCADE PALMETTO HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1852
Mailing Address - Country:US
Mailing Address - Phone:770-306-2327
Mailing Address - Fax:
Practice Address - Street 1:5150 COCHRAN MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2121
Practice Address - Country:US
Practice Address - Phone:770-774-3230
Practice Address - Fax:770-774-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities