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General NPI Number Information
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NPI Number | 1245007806
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Entity Type | Organization
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Legal Business Name | VITALIVE INC.
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1313 W BROAD AVE
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City | ALBANY
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State | GA
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Zip | 31707-4343
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Country | US
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Telephone | 229-712-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 W BROAD AVE
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City | ALBANY
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State | GA
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Zip | 31707-4343
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Country | US
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Telephone | 229-712-1007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTONIO SCREEN
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Credential |
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Telephone | 812-863-1200
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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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