Provider Demographics
NPI:1982821971
Name:CARL VISON VA MEDICAL CENTER
Entity Type:Organization
Organization Name:CARL VISON VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ICU STAFF NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:VENOID
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:478-277-2724
Mailing Address - Street 1:48 BLUEBERRY FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:GA
Mailing Address - Zip Code:31002
Mailing Address - Country:US
Mailing Address - Phone:478-668-4759
Mailing Address - Fax:
Practice Address - Street 1:48 BLUEBERRY FARM ROAD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:GA
Practice Address - Zip Code:31002
Practice Address - Country:US
Practice Address - Phone:478-668-4759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085341282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access