Provider Demographics
NPI:1073135034
Name:VEMA HOLISTIC HEALTH LLC
Entity Type:Organization
Organization Name:VEMA HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROCKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-BC
Authorized Official - Phone:229-262-3707
Mailing Address - Street 1:3338 COUNTRY CLUB RD
Mailing Address - Street 2:STE L1, PMB 182
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-6865
Practice Address - Country:US
Practice Address - Phone:229-262-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty