Provider Demographics
NPI:1437453990
Name:THE VIGOR CONSORTIUM
Entity Type:Organization
Organization Name:THE VIGOR CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA PH
Authorized Official - Phone:404-538-4945
Mailing Address - Street 1:1230 PEACHTREE ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 PEACHTREE ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3574
Practice Address - Country:US
Practice Address - Phone:404-538-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA130800108Medicaid
GA36060083Medicaid
GA380680287Medicaid