Organization Active NPI

Vital Neurology LLC

  • Neurology Physician
  • Cumming, GA
National Provider Identifier
1629951397
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
VITAL NEUROLOGY LLC
Practice address
1165 Sanders Rd
Cumming, GA 30041-5965
Phone
(802) 735-0001
NPI assigned
Jul 29, 2025
Last updated
Jul 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Authorized official

Name
Kishore RasamalluNPI 1568667863
Title
MD/Owner
Phone
(210) 379-8553

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1165 Sanders Rd
Cumming, GA 30041-5965

Mailing address

410 Peachtree Pkwy Ste 4245
Cumming, GA 30041-7407
Phone (802) 735-0001

Other practice location 1

1968 Peachtree Rd NW Fl 6
Atlanta, GA 30309-1281
Phone (802) 735-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251001003449 GA Part B Supplier - Clinic/Group Practice 2860998556 Receives reassigned benefits from 1 practitioner
Practice locations: Atlanta, GA; Cumming, GA

National Provider Directory

National Provider Directory

Locations

1165 Sanders Rd
Cumming, GA 30041
Phone (210) 379-8553

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753747200000",
    "number": "1629951397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 PEACHTREE PKWY STE 4245",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417407",
            "telephone_number": "802-735-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 SANDERS RD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415965",
            "telephone_number": "802-735-0001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1968 Peachtree Rd NW Fl 6",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303091281",
            "country_code": "US",
            "telephone_number": "802-735-0001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITAL NEUROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A",
        "authorized_official_last_name": "RASAMALLU",
        "authorized_official_first_name": "KISHORE",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "210-379-8553"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.