Provider Demographics
NPI:1780551275
Name:MEDICA VITAE HEALTH GROUP
Entity type:Organization
Organization Name:MEDICA VITAE HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEQOUN
Authorized Official - Middle Name:MARQUIS
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-293-1494
Mailing Address - Street 1:154 BARLEY CT SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3663
Mailing Address - Country:US
Mailing Address - Phone:561-293-1494
Mailing Address - Fax:
Practice Address - Street 1:154 BARLEY CT SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3663
Practice Address - Country:US
Practice Address - Phone:561-293-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies