MEDICARE: LIFE HEALTH AND WELLNESS MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639037534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HEALTH AND WELLNESS MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	403 PARKER IVEY DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6513
Country	:	US
Telephone Number	:	864-720-3390
Fax Number	:	864-288-6818

Provider Business Practice Location Address
First Line	:	403 PARKER IVEY DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6513
Country	:	US
Telephone Number	:	864-720-3390
Fax Number	:	864-288-6818

Authorized Official
Title or Position	:	OWNER
Name	:	YVETTE ERICA EDWARDS
Credential	:	DC
Telephone Number	:	864-720-3390

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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