Provider Demographics
NPI:1720350788
Name:VISIONSOUTH PC
Entity Type:Organization
Organization Name:VISIONSOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-879-2221
Mailing Address - Street 1:2700 HIGHWAY 280 S
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2420
Mailing Address - Country:US
Mailing Address - Phone:205-879-2221
Mailing Address - Fax:205-879-0615
Practice Address - Street 1:2700 HIGHWAY 280 S
Practice Address - Street 2:SUITE 212
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2420
Practice Address - Country:US
Practice Address - Phone:205-879-2221
Practice Address - Fax:205-879-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15436207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000088561Medicaid
ALE50703Medicare UPIN