Organization
LIFE LINE HOME CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE C DANIEL PHARMD (PRESIDENT)
(229) 382-1334
Entity
Organization
Contact information
Practice address
100 LAKESHORE DR, SUITE A, SAINT MARYS, GA 31558-3857
(912) 673-8544
(912) 673-8554
Mailing address
1610 MADISON AVE, TIFTON, GA 31794-3756
(912) 673-8544
(912) 673-8554
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
303718793
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0942290005
MEDICARE
—
Enumeration date
11/29/2006
Last updated
02/09/2012
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