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General NPI Number Information
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NPI Number | 1497494314
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Entity Type | Organization
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Legal Business Name | LIFECYCLE PRIMARY HEALTHCARE CENTER PC
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 6853 DOUGLAS BLVD STE C
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7179
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Country | US
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Telephone | 678-266-7150
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Fax | 678-336-1694
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Provider Business Mailing Address
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Address Line | 4529 CABINWOOD TURN
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1959
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Country | US
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Telephone | 404-587-6038
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Fax | 678-336-1694
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DEBBIE R BREWER
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Credential | MD
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Telephone | 678-266-7150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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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