Healthcare Provider Details

I. General information

NPI: 1720912744
Provider Name (Legal Business Name): VITALCORE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 DAWSON RD STE 102D
ALBANY GA
31707-2715
US

IV. Provider business mailing address

2303 DAWSON RD STE 102D
ALBANY GA
31707-2715
US

V. Phone/Fax

Practice location:
  • Phone: 229-380-3911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAY IVES
Title or Position: ORGANIZER
Credential:
Phone: 229-380-3911