NPIMap

Organization Active NPI

Vitality Ageless Center LLC

  • Multi-Specialty Clinic/Center
  • Suwanee, GA
National Provider Identifier
1730657271
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
VITALITY AGELESS CENTER LLC
Doing business as
Vitality Ageless Center LLC
Practice address
Vitality Ageless Center LLC
1300 Peachtree Industrial Blvd #1201
Suwanee, GA 30024-4686
Phone
(770) 614-6266
Fax
(770) 623-9949
NPI assigned
Nov 2, 2018
Last updated
May 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Julie Yu
Title
Owner
Phone
(770) 614-6266

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Home Health Agency 251E00000X
Clinic/Center 261Q00000X
Multi-Specialty Clinic/Center 261QM1300X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

Vitality Ageless Center LLC
1300 Peachtree Industrial Blvd #1201
Suwanee, GA 30024-4686

Mailing address

1300 Peachtree Industrial Blvd Ste 1201
Suwanee, GA 30024-4550
Phone (770) 614-6266

Other practice location 1

555 W Granada Blvd Ste E2
Ormond Beach, FL 32174-9401
Phone (386) 260-0265

Other names 1

  • Vitality Ageless Center LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL, CA, IN, IL, CO, SC7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20190325002304 GA Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 9 practitioners
Practice locations: Suwanee, GA
O20240628000026 FL Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 18 practitioners
Practice locations: Ormond Beach, FL
O20240920001696 CA Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 13 practitioners
Practice locations: Oakdale, CA
O20250110002087 IN Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 3 practitioners
Practice locations: Carmel, IN
O20250203002436 IL Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 3 practitioners
Practice locations: Chicago, IL
O20250217001207 CO Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 1 practitioner
Practice locations: Denver, CO
O20250703000766 SC Part B Supplier - Clinic/Group Practice 6800135872 Receives reassigned benefits from 3 practitioners
Practice locations: Clinton, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589

555 W Granada Blvd
Ste E2
Ormond Beach, FL 32174
Phone (386) 235-6136

1611 Satellite Blvd
Ste 3
Duluth, GA 30097
Phone (770) 614-6266

1110 Satellite Blvd NW
Ste 403
Suwanee, GA 30024
Phone (770) 614-6266

1300 Peachtree Industrial Blvd
Ste 1201
Suwanee, GA 30024
Phone (770) 614-6266

1300 Peachtree Industrial Blvd
Ste 1202
Suwanee, GA 30024
Phone (770) 614-6266

Practitioners & affiliated clinicians

Practitioners 64

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.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1730657271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD STE 1201",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244550",
            "telephone_number": "770-614-6266",
            "fax_number": "770-623-9949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VITALITY AGELESS CENTER LLC",
            "address_2": "1300 PEACHTREE INDUSTRIAL BLVD #1201",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244686",
            "telephone_number": "770-614-6266",
            "fax_number": "770-623-9949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 W Granada Blvd Ste E2",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321749401",
            "country_code": "US",
            "telephone_number": "386-260-0265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALITY AGELESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-02",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "YU",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-614-6266"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Ageless Center LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vitality Ageless Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.