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General NPI Number Information
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NPI Number | 1992578728
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Entity Type | Organization
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Legal Business Name | GOOD LIFE HEALTH LLC
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 4288 MEMORIAL DR STE A
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City | DECATUR
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State | GA
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Zip | 30032-1229
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Country | US
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Telephone | 404-998-6321
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Fax |
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Provider Business Mailing Address
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Address Line | 3679 LANTERN WALK LN
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City | SCOTTDALE
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State | GA
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Zip | 30079-1892
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Country | US
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Telephone | 678-641-2078
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | SHAHZEEN REHMAN
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Credential | NP
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Telephone | 678-641-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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