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General NPI Number Information
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NPI Number | 1336462118
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Entity Type | Organization
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Legal Business Name | LIFETIME QUALITY CARE, LLC
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 4 MEDICAL DR
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City | ELBERTON
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State | GA
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Zip | 30635-1830
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Country | US
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Telephone | 706-283-4690
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Fax | 706-283-4698
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Provider Business Mailing Address
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Address Line | PO BOX 960
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City | ELBERTON
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State | GA
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Zip | 30635-0960
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Country | US
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Telephone | 706-283-4690
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Fax | 706-283-4698
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER B BUTLER
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Credential | FNP
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Telephone | 706-283-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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