Provider Demographics
NPI:1699079673
Name:LIFESPRING COMMUNITY HEALTH
Entity type:Organization
Organization Name:LIFESPRING COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ALBURY
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-304-4525
Mailing Address - Street 1:2507 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3304
Mailing Address - Country:US
Mailing Address - Phone:423-624-4846
Mailing Address - Fax:423-624-4847
Practice Address - Street 1:2507 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3304
Practice Address - Country:US
Practice Address - Phone:423-624-4846
Practice Address - Fax:423-624-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000643706AMedicaid
TN1514642Medicaid
TN1526288Medicaid