Healthcare Provider Details

I. General information

NPI: 1679703896
Provider Name (Legal Business Name): LIFEPOINTE MEDICAL PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 GA HIGHWAY 49 N STE 900
BYRON GA
31008-4064
US

IV. Provider business mailing address

212 GA HIGHWAY 49 N STE 900
BYRON GA
31008-4064
US

V. Phone/Fax

Practice location:
  • Phone: 478-956-5433
  • Fax: 478-956-1818
Mailing address:
  • Phone: 478-956-5433
  • Fax: 478-956-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025297
License Number StateGA

VIII. Authorized Official

Name: DR. ALAN JUSTICE
Title or Position: OWNER
Credential: MD
Phone: 478-955-9402