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General NPI Number Information
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NPI Number | 1265137822
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Entity Type | Organization
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Legal Business Name | THOMAS LIFETIME HEALTH LLC
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 575 PROFESSIONAL DR STE 310
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3300
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Country | US
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Telephone | 678-376-5858
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Fax | 678-376-5500
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Provider Business Mailing Address
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Address Line | 575 PROFESSIONAL DR STE 310
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3300
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Country | US
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Telephone | 678-376-5858
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Fax | 678-376-5500
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | STEPHEN JAMES PARKER THOMAS
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Credential | MD
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Telephone | 404-783-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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