VITALITY AGELESS CENTER LLC (NPI# 1730657271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730657271 |
| Entity Type | Organization |
| Organization Name | VITALITY AGELESS CENTER LLC |
| Practice Address |
1611 Satellite Blvd Ste 3 Duluth GA 30097-4913 |
| Practice Telephone | 7706146266 |
| Practice Fax Number | 7706239949 |
| Mailing Telephone | 7706146266 |
| Mailing Fax Number | 7706239949 |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |
| Authorized Official Name | MARK STEVEN GRIMSLEY (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7706146266 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Vitality Ageless Center LLC | Doing Business As Name - Organization |
| Street Address |
1611 SATELLITE BLVD STE 3 |
| City | DULUTH |
| State | GA |
| Zip Code | 30097-4913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861729816 | Mark Steven Grimsley | Family Medicine | 1611 Satellite Blvd Ste 3, Duluth, GA 30097 | 2009-11-12 |
| 1134783368 | Mesiah O'mar Porter Jr. | Nurse Practitioner | 1611 Satellite Blvd Ste 3, Duluth, GA 30097-4913 | 2019-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659986057 | Herman Medical Solutions, LLC | Internal Medicine | 10700 Medlock Bridge Road, Suite 207, Duluth, GA 30097 | 2020-09-11 |
| 1649808619 | Kirsty Amber Ramirez | Behavior Technician | 218 Premiere Pkwy #500, Duluth, GA 30097 | 2020-03-27 |
| 1386277820 | Cristina Madalina Niculas | Pharmacist | Kroger Pharmacy 476, 6555 Sugarloaf Parkway, Duluth, GA 30097 | 2020-02-12 |
| 1619514924 | Opesdei Health Solutions | Home Health Aide | 6615 Abbotts Bridge Road, 6615 Abbotts Bridge Road Unit 1111, Johns Creek, GA 30097 | 2019-12-05 |
| 1700422979 | Ria Alexander | Nurse Practitioner | 6300 Hospital Parkway Ste 300, Johns Creek, GA 30097 | 2019-11-22 |
| 1043867765 | Mosesal Zakia White | Nurse Practitioner | 10680 Medlock Bridge Rd #102, Johns Creek, GA 30097 | 2019-08-19 |
| 1982187068 | Lighthouse Clinical Counseling, LLC | Counselor | 3883 Rogers Bridge Road, Suite 601, Duluth, GA 30097 | 2018-09-13 |
| 1376025643 | Faithe Beanne Kimsey | Counselor | 3883 Rogers Bridge Road Nw, Suite 601, Duluth, GA 30097 | 2018-09-04 |
| 1306330303 | Denise Jackson | Prosthetist | 11720 Medlock Bridge Rd Ste 155, Johns Creek, GA 30097 | 2018-06-21 |
| 1407363328 | Berkeley Van Dyke | Physical Therapist | 6335 Hospital Pkwy Ste 316, Johns Creek, GA 30097 | 2017-12-30 |
| Find all providers in zip 30097 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831710409 | Webmed LLC | Clinic/Center | 925 E Superior St Ste 113, Duluth, MN 55802-2253 | 2020-05-05 |
| 1275005498 | St. Luke's Hospital of Duluth | Clinic/Center | 1000 E 1st St Ste 204, Duluth, MN 55805-2297 | 2018-12-28 |
| 1588147839 | Ideal Option, Pllc | Clinic/Center | 831 E 2nd St, Duluth, MN 55805-2103 | 2018-09-12 |
| 1184168205 | Brown Optical | Clinic/Center | 3751 Satellite Blvd, #200, Duluth, GA 30096-8840 | 2016-12-08 |
| 1932658051 | Vaned Health LLC | Clinic/Center | 6340 Sugarloaf Pkwy Ste 200, Duluth, GA 30097-4329 | 2016-09-30 |
| 1912366931 | River Parc Internal Medicine | Clinic/Center | 4855 River Green Pkwy Ste 140, Duluth, GA 30096-8333 | 2016-02-18 |
| 1588960835 | Peachtree Chiropractic Center | Clinic/Center | 3294 Peachtree Industrial Blvd, Suite 2005, Duluth, GA 30096-8322 | 2011-02-03 |
| 1710280656 | New Gyn LLC | Clinic/Center | 3840 Peachtree Industrial Blvd, 275, Duluth, GA 30096-5031 | 2010-12-15 |
| 1063726743 | St. Luke's Hospital | Clinic/Center | 915 E 1st St, Duluth, MN 55805-2107 | 2010-08-05 |
| 1447427232 | Rediclinic Us, LLC | Clinic/Center | 2635 Pleasant Hill Rd, Duluth, GA 30096-1450 | 2008-05-12 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.