Healthcare Provider Details

I. General information

NPI: 1932070547
Provider Name (Legal Business Name): VITALFORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LAKE KNOLL DR NW
LILBURN GA
30047-8709
US

IV. Provider business mailing address

630 LAKE KNOLL DR NW
LILBURN GA
30047-8709
US

V. Phone/Fax

Practice location:
  • Phone: 917-525-2517
  • Fax:
Mailing address:
  • Phone: 917-525-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD KHAN
Title or Position: OWNER
Credential:
Phone: 917-525-2517