Healthcare Provider Details

I. General information

NPI: 1942135678
Provider Name (Legal Business Name): VITAL BRIDGES MEDICAL CONCIERGE AND AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 WALL STREET SE SUITE 240, ROOM 95
CONYERS GA
30013
US

IV. Provider business mailing address

2375 WALL STREET SE SUITE 240, RM 95
CONYERS GA
30013-2296
US

V. Phone/Fax

Practice location:
  • Phone: 770-372-9831
  • Fax:
Mailing address:
  • Phone: 770-372-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. D'NEKA BRIDGES
Title or Position: PHYSICIAN ASSOCIATE
Credential: PA
Phone: 404-276-5919