Healthcare Provider Details

I. General information

NPI: 1780544627
Provider Name (Legal Business Name): VITALIZE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N POINTE CIR
AMERICUS GA
31709-7965
US

IV. Provider business mailing address

122 N POINTE CIR
AMERICUS GA
31709-7965
US

V. Phone/Fax

Practice location:
  • Phone: 229-938-6403
  • Fax:
Mailing address:
  • Phone: 229-938-6403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAKESHA HIGH
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 229-938-6403