Provider Demographics
NPI:1659040285
Name:VITA-INFUSION & WELLNESS
Entity Type:Organization
Organization Name:VITA-INFUSION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-689-0807
Mailing Address - Street 1:901 WOODLAND ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3792
Mailing Address - Country:US
Mailing Address - Phone:615-689-0807
Mailing Address - Fax:
Practice Address - Street 1:901 WOODLAND ST STE 104
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3792
Practice Address - Country:US
Practice Address - Phone:615-689-0807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty