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General NPI Number Information
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NPI Number | 1801543459
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Entity Type | Organization
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Legal Business Name | LIFE DEVELOPMENT & HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 3355 LENOX RD NE STE 750
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City | ATLANTA
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State | GA
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Zip | 30326-1353
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Country | US
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Telephone | 866-806-5347
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Fax | 216-710-6801
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Provider Business Mailing Address
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Address Line | 12848 QUEENSBURY LN STE 208
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City | HOUSTON
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State | TX
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Zip | 77024-4163
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Country | US
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Telephone | 866-806-5347
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Fax | 216-710-6801
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Authorized Official
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Title or Position | CEO
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Name | AUSTIN GEORGE BENAMON
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Credential |
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Telephone | 866-806-5347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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