# LIFESOURCE PRIME INC

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

## Provider details

- **NPI number:** 1598533275
- **Authorized official:** PEGGY BADDOUR (CEO)
- **Authorized official phone:** (910) 742-9243

## Contact information

- **Practice address:** 3205 RANDALL PKWY STE 105, WILMINGTON, NC 28403-2565
- **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) 338-2882
- **Mailing address fax:** (888) 746-1787

## Taxonomy

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

## Other

- **Enumeration date:** 12/13/2023
- **Last updated:** 10/28/2025