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Organization
VIVASALUD CLINIC 1 LLC
Active
Organization
VIVASALUD CLINIC 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA JIMENEZ NP (CHIEF CLINICAL OPERATIONS OFFICER)
(470) 607-5533
Entity
Organization
Contact information
Practice address
2336 WISTERIA DR STE 110, SNELLVILLE, GA 30078-6162
(470) 342-8500
Mailing address
2336 WISTERIA DR STE 110, SNELLVILLE, GA 30078-6162
(470) 481-7803
(833) 941-5113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003284553A
—
GA
Enumeration date
10/25/2022
Last updated
02/15/2026
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