LIFESOURCE PRIME INC

ROME, GA
NPI1841155181
Entity TypeOrganization
Authorized ContactTABITHA HOFFMAN
Credentialing
910-777-9165
Organization Subpart ?No
Primary Taxonomy207R00000X Internal Medicine
Additional Taxonomies207Q00000X Family Medicine
363A00000X Physician Assistant
363L00000X Nurse Practitioner
Enumeration Date2025-12-18
Last Update Date2025-12-18
Business Address
LIFESOURCE PRIME INC
1345 REDMOND CIR NW
ROME, GA 30165-1307
Phone number: 910-742-9243
Mailing Address
LIFESOURCE PRIME INC
PO BOX 740343
ATLANTA, GA 30374-0343
Phone number: 910-742-9243