Organization
VITALOCITY URGENT CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSCOE CARL WALLS FNP-BC (OWNER)
(912) 785-2676
Entity
Organization
Contact information
Practice address
118 AZALEA RD, ST 1, BAXLEY, GA 31513
(912) 785-2676
Mailing address
118 AZALEA RD, ST 1, BAXLEY, GA 31513
(912) 309-2233
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376231597
—
GA
Enumeration date
09/09/2024
Last updated
12/06/2024
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