# LIFESOURCE PRIME INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548124159
- **Authorized official:** ERYN M ROBBINS (VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (910) 622-2319

## Contact information

- **Practice address:** 1901 LIBBIE AVE, RICHMOND, VA 23226-1808
- **Practice address phone:** (910) 742-9243
- **Practice address fax:** (888) 746-1787
- **Mailing address:** PO BOX 740343, ATLANTA, GA 30374-0343
- **Mailing address phone:** (910) 338-2877
- **Mailing address fax:** (877) 335-9071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/10/2025
- **Last updated:** 12/10/2025