NPIMap

Organization Active NPI

Rejuvenation Wellness LLC

  • Family Medicine Physician
  • Homewood, AL
National Provider Identifier
1619397247
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
AL24915 Issued in AL
Legal business name
REJUVENATION WELLNESS LLC
Practice address
2704 20TH Street South
Suite 104
Homewood, AL 35209
Phone
(205) 413-8599
Fax
(205) 383-2425
NPI assigned
Apr 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Authorized official

Name
Farah Taj Sultan, MDNPI 1750499596
Title
Owner/Medical Director
Phone
(205) 413-8599

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X AL24915 AL Primary

Addresses

Primary practice location

2704 20TH Street South
Suite 104
Homewood, AL 35209

Mailing address

2704 20TH Street South
Suite 104
Homewood, AL 35209
Phone (205) 413-8599

Other names 1

  • Vitalogy Wellness Center Doing business as

National Provider Directory

National Provider Directory

Locations

2704 20th St S
#104
Homewood, AL 35209
Phone (205) 412-8599

Practitioners & affiliated clinicians

Practitioners 2

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": "1398124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1619397247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 20TH STREET SOUTH",
            "address_2": "SUITE 104",
            "city": "HOMEWOOD",
            "state": "AL",
            "postal_code": "35209",
            "telephone_number": "205-413-8599",
            "fax_number": "205-383-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 20TH STREET SOUTH",
            "address_2": "SUITE 104",
            "city": "HOMEWOOD",
            "state": "AL",
            "postal_code": "35209",
            "telephone_number": "205-413-8599",
            "fax_number": "205-383-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENATION WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-22",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "SULTAN",
        "authorized_official_first_name": "FARAH",
        "authorized_official_middle_name": "TAJ",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "205-413-8599",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "AL24915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitalogy Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Homewood, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; 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.