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General NPI Number Information
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NPI Number | 1912270471
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Entity Type | Organization
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Legal Business Name | LIFE LINE HOME CARE INC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1350 SPRING ST NW SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30309-2864
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Country | US
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Telephone | 404-876-1503
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Fax | 404-876-1505
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Provider Business Mailing Address
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Address Line | 1610 MADISON AVE
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City | TIFTON
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State | GA
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Zip | 31794-3756
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Country | US
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Telephone | 229-382-1334
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Fax | 229-382-1350
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONNIE C DANIEL
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Credential | PHARMD
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Telephone | 229-382-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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