Provider Demographics
NPI:1629474796
Name:LIFELINE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:LIFELINE MEDICAL CENTER, LLC
Other - Org Name:LIFELINE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-355-7896
Mailing Address - Street 1:3660 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1246
Mailing Address - Country:US
Mailing Address - Phone:470-355-7896
Mailing Address - Fax:
Practice Address - Street 1:3660 MARKET ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1246
Practice Address - Country:US
Practice Address - Phone:470-355-7896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELINE MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty