Healthcare Provider Details

I. General information

NPI: 1972780369
Provider Name (Legal Business Name): LIFEPOINTE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 GA HIGHWAY 49 N SUITE
BYRON GA
31008-4057
US

IV. Provider business mailing address

212 GA HIGHWAY 49 N SUITE 900
BYRON GA
31008-4057
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number059799
License Number StateGA

VIII. Authorized Official

Name: TONYA SUTTON
Title or Position: INS. COORDINATOR
Credential:
Phone: 478-475-1299