| NPI | 1962940817 |
|---|---|
| Doing Business As | LIFESOURCE OF GEORGIA |
| Entity Type | Organization |
| Authorized Contact | PEGGY L BADDOUR President 910-777-9165 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 1041C0700X Social Worker, Clinical | |
| 207Q00000X Family Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2021-03-26 |