Provider Demographics
NPI:1679703896
Name:LIFEPOINTE MEDICAL PROVIDERS LLC
Entity type:Organization
Organization Name:LIFEPOINTE MEDICAL PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-955-9402
Mailing Address - Street 1:212 GA HIGHWAY 49 N STE 900
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-4064
Mailing Address - Country:US
Mailing Address - Phone:478-956-5433
Mailing Address - Fax:478-956-1818
Practice Address - Street 1:212 GA HIGHWAY 49 N STE 900
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-4064
Practice Address - Country:US
Practice Address - Phone:478-956-5433
Practice Address - Fax:478-956-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty