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General NPI Number Information
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NPI Number | 1902176233
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Entity Type | Organization
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Legal Business Name | LIFE TIME CARE
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 2993 SANDY PLAINS RD SUITE 115
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City | MARIETTA
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State | GA
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Zip | 30066-4695
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Country | US
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Telephone | 404-273-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 2993 SANDY PLAINS RD SUITE 115
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City | MARIETTA
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State | GA
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Zip | 30066-4695
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER J WILLIAMS
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Credential | D.C.
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Telephone | 404-273-2736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 02787
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License Number State | GA
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