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Organization
VITALITY AGELESS CENTER LLC
Active
Organization
VITALITY AGELESS CENTER LLC
Active
Other names
Vitality Ageless Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE YU (OWNER)
(770) 614-6266
Entity
Organization
Contact information
Practice address
VITALITY AGELESS CENTER LLC, 1300 PEACHTREE INDUSTRIAL BLVD #1201, SUWANEE, GA 30024-4686
(770) 614-6266
(770) 623-9949
Mailing address
1300 PEACHTREE INDUSTRIAL BLVD STE 1201, SUWANEE, GA 30024-4550
(770) 614-6266
(770) 623-9949
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
251E00000X
Home Health Agency
—
NULL
261Q00000X
Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Enumeration date
11/02/2018
Last updated
05/09/2024
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