# ICECARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VitalCare Express
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366202236
- **Authorized official:** ANTHONY CHUKWUEMEKA C IWELUNMOR MD (MD)
- **Authorized official phone:** (770) 800-3277

## Contact information

- **Practice address:** 976 MANSELL RD, ROSWELL, GA 30076-1533
- **Practice address phone:** (770) 800-3277
- **Practice address fax:** (770) 800-3537
- **Mailing address:** 976 MANSELL RD, ROSWELL, GA 30076-1533
- **Mailing address phone:** (770) 800-3277
- **Mailing address fax:** (770) 800-3537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |

## Other

- **Enumeration date:** 03/19/2024
- **Last updated:** 03/19/2024