1639450364 NPI number — VITALITY REHAB CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639450364 NPI number — VITALITY REHAB CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITALITY REHAB CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639450364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4191 SNAPFINGER WOODS DR STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30035-3432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-288-4347
Provider Business Mailing Address Fax Number:
404-288-4057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4191 SNAPFINGER WOODS DR STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30035-3432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-288-4347
Provider Business Practice Location Address Fax Number:
404-288-4057
Provider Enumeration Date:
09/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREENWOOD
Authorized Official First Name:
KOBIE
Authorized Official Middle Name:
OKERA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
404-288-4347

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)