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General NPI Number Information
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NPI Number | 1629951397
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Entity Type | Organization
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Legal Business Name | VITAL NEUROLOGY LLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1165 SANDERS RD
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City | CUMMING
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State | GA
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Zip | 30041-5965
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Country | US
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Telephone | 802-735-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 410 PEACHTREE PKWY STE 4245
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City | CUMMING
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State | GA
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Zip | 30041-7407
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Country | US
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Telephone | 802-735-0001
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | KISHORE RASAMALLU
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Credential |
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Telephone | 210-379-8553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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