Healthcare Provider Details

I. General information

NPI: 1346164837
Provider Name (Legal Business Name): VITA BRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GARLINGTON AVE APT 37
WAYCROSS GA
31503-2711
US

IV. Provider business mailing address

2021 N SLAPPEY BLVD # 152
ALBANY GA
31701-1001
US

V. Phone/Fax

Practice location:
  • Phone: 229-621-5585
  • Fax:
Mailing address:
  • Phone: 229-621-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHEMIKA LAVETTE BARNES
Title or Position: ORGANIZER
Credential:
Phone: 229-621-5585