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General NPI Number Information
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NPI Number | 1326843277
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Entity Type | Organization
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Legal Business Name | VITALITY AGELESS CENTER LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 5100 POPLAR AVE FL 27
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City | MEMPHIS
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State | TN
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Zip | 38137-2701
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Country | US
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Telephone | 770-614-6266
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 PEACHTREE INDUSTRIAL BLVD STE 1201
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City | SUWANEE
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State | GA
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Zip | 30024-4550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AO
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Name | JESSICA JONES
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Credential |
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Telephone | 215-292-0275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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