Organization
VITALITY MEDICAL CENTERS OF NORTH AUGUSTA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON B FARMER (OWNER)
(803) 244-9212
Entity
Organization
Contact information
Practice address
440 W MARTINTOWN RD STE 200, NORTH AUGUSTA, SC 29841-3106
(803) 265-2015
Mailing address
PO BOX 7227, WEST COLUMBIA, SC 29171-7227
(803) 218-9886
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7172
—
SC
Enumeration date
12/21/2015
Last updated
08/30/2024
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