Basic Information
Provider Information
NPI: 1073562922
EntityType: 2
ReplacementNPI:  
OrganizationName: VISION MEDICAL CONSULTING, P.C.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GEORGIA LONG TERM CARE AND CONSULTING
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 13003
Address2:  
City: ATLANTA
State: GA
PostalCode: 303240003
CountryCode: US
TelephoneNumber: 7709381757
FaxNumber: 7709381759
Practice Location
Address1: 1990 LAKESIDE PKWY
Address2: SUITE 170
City: TUCKER
State: GA
PostalCode: 300845884
CountryCode: US
TelephoneNumber: 7709381757
FaxNumber: 7709381759
Other Information
ProviderEnumerationDate: 05/09/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FRINKS
AuthorizedOfficialFirstName: TERENCE
AuthorizedOfficialMiddleName: ANDREW
AuthorizedOfficialTitleorPosition: PRESIDENT/CEO
AuthorizedOfficialTelephone: 7709381757
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X051042GAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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