Provider Demographics
NPI:1992578728
Name:GOOD LIFE HEALTH LLC
Entity type:Organization
Organization Name:GOOD LIFE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-641-2078
Mailing Address - Street 1:3679 LANTERN WALK LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1892
Mailing Address - Country:US
Mailing Address - Phone:678-641-2078
Mailing Address - Fax:
Practice Address - Street 1:4288 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1229
Practice Address - Country:US
Practice Address - Phone:404-998-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty