NPIMap

Organization Active NPI

Vitalmed

  • Health Service Clinic/Center
  • Conyers, GA
National Provider Identifier
1275357063
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
VITALMED
Practice address
3502 McCallister LN
Conyers, GA 30013-7500
Phone
(561) 449-1129
NPI assigned
Nov 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tia Denae KingNPI 1841740206
Title
Nurse Practitioner
Phone
(561) 449-1129

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

3502 McCallister LN
Conyers, GA 30013-7500

Mailing address

3502 McCallister LN
Conyers, GA 30013-7500
Phone (561) 449-1129

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1275357063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 MCCALLISTER LN",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300137500",
            "telephone_number": "561-449-1129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 MCCALLISTER LN",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300137500",
            "telephone_number": "561-449-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALMED",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-08",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "TIA",
        "authorized_official_middle_name": "DENAE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "561-449-1129"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.