Healthcare Provider Details

I. General information

NPI: 1972021301
Provider Name (Legal Business Name): VITAL LIVING HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 PEACHTREE DUNWOODY RD STE 200
ATLANTA GA
30328-5684
US

IV. Provider business mailing address

6115 PEACHTREE DUNWOODY RD STE 200
ATLANTA GA
30328-5684
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-3636
  • Fax: 404-891-7164
Mailing address:
  • Phone: 404-843-3636
  • Fax: 404-891-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number049762
License Number StateGA

VIII. Authorized Official

Name: DR. PAUL E. COX
Title or Position: OWNER
Credential: MD
Phone: 404-843-3636