Provider Demographics
NPI:1639450364
Name:VITALITY REHAB CENTER
Entity Type:Organization
Organization Name:VITALITY REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KOBIE
Authorized Official - Middle Name:OKERA
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-288-4347
Mailing Address - Street 1:4191 SNAPFINGER WOODS DR STE D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3432
Mailing Address - Country:US
Mailing Address - Phone:404-288-4347
Mailing Address - Fax:404-288-4057
Practice Address - Street 1:4191 SNAPFINGER WOODS DR STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3432
Practice Address - Country:US
Practice Address - Phone:404-288-4347
Practice Address - Fax:404-288-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty