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General NPI Number Information
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NPI Number | 1639426984
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Entity Type | Organization
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Legal Business Name | LIFELINE PRIMARY CARE, INC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 4025 LAWRENCEVILLE HWY NW STE A
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City | LILBURN
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State | GA
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Zip | 30047-2876
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Country | US
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Telephone | 770-559-3501
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Fax | 770-696-9078
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Provider Business Mailing Address
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Address Line | 4025 LAWRENCEVILLE HWY NW STE A
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City | LILBURN
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State | GA
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Zip | 30047-2876
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Country | US
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Telephone | 770-559-3501
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Fax | 770-696-9078
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | MR. AZIZ A PIRANI
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Credential | M.D.
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Telephone | 770-559-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 61934
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License Number State | GA
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