Vitality Mens Health and Wellness, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

46215 Issued in TN

Legal business name

VITALITY MENS HEALTH AND WELLNESS, LLC

Practice address

6655 Poplar Ave
Suite 204
Germantown, TN 38138-3691

Phone

(901) 751-4477

Fax

(901) 751-4488

NPI assigned

Sep 21, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Christy Long

Title

Credentialing

Phone

(901) 737-1992

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326931200000",
    "number": "1427331982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6655 POPLAR AVE",
            "address_2": "SUITE 204",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381383691",
            "telephone_number": "901-751-4477",
            "fax_number": "901-751-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6655 POPLAR AVE",
            "address_2": "SUITE 204",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381383691",
            "telephone_number": "901-751-4477",
            "fax_number": "901-751-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY MENS HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-21",
        "last_updated": "2012-01-19",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "901-737-1992",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "46215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy Rae Vincent, COTA
• John Robert Vincent, M.D.
• Jason M Vinson, PHARMD
• Kyle Benjamin Vinson, MD
• Lenell Vitale, MS,OTR/L
• Tuong Cat Vo
• Val Y Vogt, MD
• VRF Eye Specialty Group, PLC
• Stanley R Waddell, D.D.S.
• Amber June Wade, PA-C

• Internal Medicine Physician in Germantown, TN
• Providers in Germantown, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; 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.