| Lifesource Of Alabama | |
|
1424 Montclair Rd Irondale AL 35210-2208 | |
| (910) 742-9243 | |
| Not Available |
| Full Name | Lifesource Of Alabama |
|---|---|
| Speciality | General Practice |
| Location | 1424 Montclair Rd, Irondale, Alabama |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT/OWNER) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of Alabama Po Box 538622 Atlanta GA 30353-8622 Ph: () - | Lifesource Of Alabama 1424 Montclair Rd Irondale AL 35210-2208 Ph: (910) 742-9243 |
| NPI Number | 1821535428 |
|---|---|
| Provider Enumeration Date | 01/21/2017 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20170412001175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821535428 | NPI | - | NPPES |
| Provider Name | Jill Sims-hill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699720284 PECOS PAC ID: 5991985392 Enrollment ID: I20110201000903 |
| Provider Name | Shalita Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396214060 PECOS PAC ID: 1153662283 Enrollment ID: I20190417002677 |
| Provider Name | Jenissa Chintella |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326398991 PECOS PAC ID: 4688933542 Enrollment ID: I20210610001451 |
| Provider Name | Terraseeta Craig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366908287 PECOS PAC ID: 9739574021 Enrollment ID: I20220323002859 |
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