Provider Demographics
NPI:1891525572
Name:LIFELINE PRIMARY CARE, INC
Entity type:Organization
Organization Name:LIFELINE PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-559-3501
Mailing Address - Street 1:4025 LAWRENCEVILLE HWY NW STE A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2876
Mailing Address - Country:US
Mailing Address - Phone:770-559-3501
Mailing Address - Fax:678-868-1100
Practice Address - Street 1:1940 PARKER CT STE A
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3456
Practice Address - Country:US
Practice Address - Phone:770-559-3501
Practice Address - Fax:678-868-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty