| Vitality Ageless Center Llc | |
|
Vitality Ageless Center Llc 1300 Peachtree Industrial Blvd #1201 Suwanee GA 30024-4686 | |
| (770) 614-6266 | |
| (770) 623-9949 |
| Full Name | Vitality Ageless Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | Vitality Ageless Center Llc, Suwanee, Georgia |
| Authorized Official Name and Position | Julie Yu (OWNER) |
| Authorized Official Contact | 7706146266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Ageless Center Llc 1300 Peachtree Industrial Blvd Ste 1201 Suwanee GA 30024-4550 Ph: (770) 614-6266 | Vitality Ageless Center Llc Vitality Ageless Center Llc 1300 Peachtree Industrial Blvd #1201 Suwanee GA 30024-4686 Ph: (770) 614-6266 |
| NPI Number | 1730657271 |
|---|---|
| Provider Enumeration Date | 11/02/2018 |
| Last Update Date | 05/09/2024 |
| Medicare PECOS PAC ID | 6800135872 |
|---|---|
| Medicare Enrollment ID | O20190325002304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730657271 | NPI | - | NPPES |
| Provider Name | Lequawn M James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154834406 PECOS PAC ID: 4688005598 Enrollment ID: I20201209002305 |
| Provider Name | Linda P Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093291544 PECOS PAC ID: 6204225543 Enrollment ID: I20211108002257 |
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