Provider Demographics
NPI:1497494314
Name:LIFECYCLE PRIMARY HEALTHCARE CENTER PC
Entity Type:Organization
Organization Name:LIFECYCLE PRIMARY HEALTHCARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-266-7150
Mailing Address - Street 1:4529 CABINWOOD TURN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1959
Mailing Address - Country:US
Mailing Address - Phone:404-587-6038
Mailing Address - Fax:678-336-1694
Practice Address - Street 1:6853 DOUGLAS BLVD STE C
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7179
Practice Address - Country:US
Practice Address - Phone:678-266-7150
Practice Address - Fax:678-336-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty