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
—
—
251E00000X
Home Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/02/2018
Last updated
05/09/2024
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