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General NPI Number Information
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NPI Number | 1124854153
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Entity Type | Organization
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Legal Business Name | VITALOCITY URGENT CARE, LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 118 AZALEA RD ST 1
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City | BAXLEY
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State | GA
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Zip | 31513
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Country | US
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Telephone | 912-785-2676
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Fax |
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Provider Business Mailing Address
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Address Line | 118 AZALEA RD ST 1
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City | BAXLEY
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State | GA
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Zip | 31513
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Country | US
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Telephone | 912-309-2233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSCOE CARL WALLS
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Credential | FNP-BC
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Telephone | 912-785-2676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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