Provider Demographics
NPI:1972021301
Name:VITAL LIVING HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:VITAL LIVING HEALTHCARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-843-3636
Mailing Address - Street 1:6115 PEACHTREE DUNWOODY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5684
Mailing Address - Country:US
Mailing Address - Phone:404-843-3636
Mailing Address - Fax:404-891-7164
Practice Address - Street 1:6115 PEACHTREE DUNWOODY RD STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5684
Practice Address - Country:US
Practice Address - Phone:404-843-3636
Practice Address - Fax:404-891-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049762207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty