Organization
LIFETIME MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE KENT (ADMINISTRATOR)
(706) 698-5433
Entity
Organization
Contact information
Practice address
14244 HIGHWAY 515 N, SUITE 100, ELLIJAY, GA 30536
(706) 698-5433
Mailing address
14244 HIGHWAY 515 N, SUITE 100, ELLIJAY, GA 30536
(706) 698-5433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
051241
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202 G701 589
MEDICARE GROUP #
GA
Enumeration date
12/17/2009
Last updated
08/13/2014
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