Healthcare Provider Details

I. General information

NPI: 1093482903
Provider Name (Legal Business Name): LIFEHOPE MOBILE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 GREAT OAKS WAY STE 300
ALPHARETTA GA
30022-2459
US

IV. Provider business mailing address

3330 PRESTON RIDGE RD STE 380
ALPHARETTA GA
30005-4596
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-6358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT HONAN
Title or Position: SOLE MEMBER
Credential:
Phone: 404-255-6358