Organization
LIFE HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH GREGORY (RECRUITER)
(303) 730-1902
Entity
Organization
Contact information
Practice address
3382 KNIGHTON RDG, POWDER SPRINGS, GA 30127-2160
(770) 780-7825
Mailing address
3382 KNIGHTON RDG, POWDER SPRINGS, GA 30127-2160
(770) 780-7825
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
RN167846
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208D00000X
—
GA
Enumeration date
04/26/2017
Last updated
04/26/2017
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