| Life Healing Center Pc | |
|
2160 Fountain Dr Snellville GA 30078-7022 | |
| (678) 344-8268 | |
| (888) 627-6444 |
| Full Name | Life Healing Center Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2160 Fountain Dr, Snellville, Georgia |
| Authorized Official Name and Position | Muhammad Ahmed (OWNER) |
| Authorized Official Contact | 6783448268 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Healing Center Pc 2160 Fountain Dr Ste 100 Snellville GA 30078-7022 Ph: (678) 344-8268 | Life Healing Center Pc 2160 Fountain Dr Snellville GA 30078-7022 Ph: (678) 344-8268 |
| NPI Number | 1104149160 |
|---|---|
| Provider Enumeration Date | 03/04/2010 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/13/2024 |
| Medicare PECOS PAC ID | 9638294309 |
|---|---|
| Medicare Enrollment ID | O20100917000834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104149160 | NPI | - | NPPES |
| 1043302037 | Other | INDIVIDUAL NPI | |
| 985642402A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 061687 (Georgia) | Primary |
| Provider Name | Muhammad S Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043302037 PECOS PAC ID: 2860541364 Enrollment ID: I20090512000386 |
| Provider Name | Julia J Waller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588964795 PECOS PAC ID: 2365684925 Enrollment ID: I20130809000524 |
| Provider Name | Charles Guillaume |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114322419 PECOS PAC ID: 4981996378 Enrollment ID: I20160705001421 |
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