Provider Demographics
NPI:1740751221
Name:LIFEBRITE PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:LIFEBRITE PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-359-8629
Mailing Address - Street 1:3970 FIVE FORKS TRICKUM RD SW STE A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2339
Mailing Address - Country:US
Mailing Address - Phone:855-359-8629
Mailing Address - Fax:678-310-1355
Practice Address - Street 1:3970 FIVE FORKS TRICKUM RD SW STE A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2339
Practice Address - Country:US
Practice Address - Phone:855-359-8629
Practice Address - Fax:678-310-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty