Healthcare Provider Details

I. General information

NPI: 1922531953
Provider Name (Legal Business Name): LIFEBRITE HOSPITAL GROUP OF EARLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

IV. Provider business mailing address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

V. Phone/Fax

Practice location:
  • Phone: 229-723-4841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009691
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MORGAN DUNN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-849-6440