Organization · Type 2 NPI

Lifesource of North Carolina

General Practice Physician · Rome, GA

NPI number 1962940817 Active

Practice location

1345 Redmond Cir NW
Rome, GA 30165-1307

Call (910) 742-9243 Map

Fax (888) 746-1787

Mailing address

PO Box 538622
Atlanta, GA 30353-8622

Specialties and licenses

Taxonomy	Code	License
Psychologist	103T00000X	None listed
Clinical Social Worker	1041C0700X	None listed
Family Medicine Physician	207Q00000X	None listed
Psychiatry Physician	2084P0800X	None listed
General Practice Physician Primary	208D00000X	None listed
Physician Assistant	363A00000X	None listed
Nurse Practitioner	363L00000X	None listed

General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

14 other providers at this address

Other general practice physician providers in Rome

MC Medical LLCGeneral Practice Physician Rome, GA NPI 1174930150

See all in Rome →

NPI record

NPI: 1962940817
Entity type: Organization (Type 2)
Issued: Feb 10, 2017
Last updated: Mar 26, 2021
Status: Active
Subpart: Yes of Lifesource of North Carolina

Other names

<unavail>
Lifesource of Georgia · doing business as
Lifesource of Georgia · doing business as

Authorized official

Peggy L Baddour
President
(910) 777-9165

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1962940817

Lifesource of North Carolina's National Provider Identifier is 1962940817, issued on Feb 10, 2017. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in Rome, GA. The record was last updated on Mar 26, 2021.