Healthcare Provider Details

I. General information

NPI: 1437453990
Provider Name (Legal Business Name): THE VIGOR CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 PEACHTREE ST SUITE 1800
ATLANTA GA
30309-3574
US

IV. Provider business mailing address

1230 PEACHTREE ST SUITE 1800
ATLANTA GA
30309-3574
US

V. Phone/Fax

Practice location:
  • Phone: 404-538-4945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC ALLEN
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA PH
Phone: 404-538-4945