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General NPI Number Information
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NPI Number | 1639539455
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL LLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 16415 NORTHCROSS DR SUITE A
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5001
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Country | US
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Telephone | 704-895-5448
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Fax | 704-896-1761
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Provider Business Mailing Address
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Address Line | 12228 JOURNEYS END TRL
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-2422
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Country | US
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Telephone | 704-895-5448
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Fax | 704-896-1761
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON R PATTEN
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Credential | MD
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Telephone | 334-717-1073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 2014-01121
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License Number State | NC
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