Healthcare Provider Details

I. General information

NPI: 1073318531
Provider Name (Legal Business Name): RT4LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 FLAGSTONE LN
CONYERS GA
30012-6509
US

IV. Provider business mailing address

1660 FLAGSTONE LN
CONYERS GA
30012-6509
US

V. Phone/Fax

Practice location:
  • Phone: 770-598-2800
  • Fax:
Mailing address:
  • Phone: 770-598-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA ANN MARIA
Title or Position: PROVIDER
Credential: RCP
Phone: 770-598-2800