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General NPI Number Information
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NPI Number | 1417867417
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Entity Type | Organization
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Legal Business Name | LIFESOURCE ACCOUNTABILITY INC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 939 SPRINGDALE DR
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City | CLINTON
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State | SC
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Zip | 29325-7266
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Country | US
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Telephone | 910-742-9243
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Fax | 888-746-1787
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Provider Business Mailing Address
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Address Line | 3205 RANDALL PKWY STE 105
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City | WILMINGTON
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State | NC
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Zip | 28403-2565
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Country | US
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Telephone | 910-742-9243
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Fax | 888-746-1787
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | ERYN M ROBBINS
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Credential |
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Telephone | 910-622-2319
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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