# REJUVENATION WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vitalogy Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619397247
- **Authorized official:** FARAH TAJ SULTAN MD (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (205) 413-8599

## Contact information

- **Practice address:** 2704 20TH STREET SOUTH, SUITE 104, HOMEWOOD, AL 35209
- **Practice address phone:** (205) 413-8599
- **Practice address fax:** (205) 383-2425
- **Mailing address:** 2704 20TH STREET SOUTH, SUITE 104, HOMEWOOD, AL 35209
- **Mailing address phone:** (205) 413-8599
- **Mailing address fax:** (205) 383-2425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | AL24915 | AL | Yes |

## Other

- **Enumeration date:** 04/22/2014
- **Last updated:** 04/22/2014