Provider Demographics
NPI:1134389695
Name:VISUAL CELL TECH
Entity type:Organization
Organization Name:VISUAL CELL TECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-270-0355
Mailing Address - Street 1:1479 BROCKETT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:770-270-0355
Mailing Address - Fax:
Practice Address - Street 1:1479 BROCKETT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7326
Practice Address - Country:US
Practice Address - Phone:770-270-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service