Organization
VITALITY WELLNESS CLINIC LLC
Active
Other names
Vitality Medical Clinic and Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON BRADLEY CROWDER M.D. (OWNER)
(251) 591-9769
Entity
Organization
Contact information
Practice address
3200 MALLETT RD, D-3, D'IBERVILLE, MS 39540-9305
(228) 392-0900
(228) 392-0902
Mailing address
3200 MALLETT RD, SUITE D-3, D'IBERVILLE, MS 39540-9305
(228) 392-0900
(228) 392-0902
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20041
MS
Other
Enumeration date
05/12/2012
Last updated
08/28/2012
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