Provider Demographics
NPI:1013321702
Name:LIFELINE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:LIFELINE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-580-0950
Mailing Address - Street 1:3330 PEACHTREE CORNERS CIR STE H
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3657
Mailing Address - Country:US
Mailing Address - Phone:678-580-0950
Mailing Address - Fax:678-580-0991
Practice Address - Street 1:3330 PEACHTREE CORNERS CIR STE H
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3657
Practice Address - Country:US
Practice Address - Phone:678-580-0950
Practice Address - Fax:678-580-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056624261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA056624OtherLIC
GA267992339CMedicaid
GA267992339CMedicaid
GA111883Medicare Oscar/Certification
GAI46366Medicare UPIN
GABP9393377OtherDEA