| Lifesource Prime Inc | |
|
939 Springdale Dr Clinton SC 29325-7266 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Prime Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 939 Springdale Dr, Clinton, South Carolina |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT/OWNER) |
| Authorized Official Contact | 9107429243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Prime Inc Po Box 740343 Atlanta GA 30374-0343 Ph: (910) 338-2885 | Lifesource Prime Inc 939 Springdale Dr Clinton SC 29325-7266 Ph: (910) 742-9243 |
| NPI Number | 1851143523 |
|---|---|
| Provider Enumeration Date | 04/04/2024 |
| Last Update Date | 10/28/2025 |
| Certification Date | 10/28/2025 |
| Medicare PECOS PAC ID | 7810336385 |
|---|---|
| Medicare Enrollment ID | O20240613002055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851143523 | NPI | - | NPPES |
| Provider Name | William M Anderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831148667 PECOS PAC ID: 7012816085 Enrollment ID: I20040108000290 |
| Provider Name | Brandy K Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578532040 PECOS PAC ID: 2062465362 Enrollment ID: I20050228000138 |
| Provider Name | Monica M Denoux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003259235 PECOS PAC ID: 7012157456 Enrollment ID: I20130709000419 |
| Provider Name | Ishan Bhansaly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972824357 PECOS PAC ID: 6507004157 Enrollment ID: I20131003000071 |
| Provider Name | July Romely Damour |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851470215 PECOS PAC ID: 2567656457 Enrollment ID: I20140703002176 |
| Provider Name | Peter L Zervos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619111804 PECOS PAC ID: 0446415194 Enrollment ID: I20141113001813 |
| Provider Name | Karen J Fulwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164414520 PECOS PAC ID: 6608923578 Enrollment ID: I20141124000655 |
| Provider Name | Kimberly B Trammell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144603648 PECOS PAC ID: 3072826643 Enrollment ID: I20150727000139 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20160205000714 |
| Provider Name | Tina Goethie-lyons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376915934 PECOS PAC ID: 0547558637 Enrollment ID: I20161005000353 |
| Provider Name | La'quandra Rampersant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336519776 PECOS PAC ID: 0941582829 Enrollment ID: I20170130001445 |
| Provider Name | Elizabeth Ann Hinz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699181230 PECOS PAC ID: 2860750304 Enrollment ID: I20171211002089 |
| Provider Name | Lisa Mcarthur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659875565 PECOS PAC ID: 2163787193 Enrollment ID: I20180523000055 |
| Provider Name | Michael Anthony Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568950426 PECOS PAC ID: 3577818780 Enrollment ID: I20180612001071 |
| Provider Name | Janette S Shelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699257196 PECOS PAC ID: 0143574368 Enrollment ID: I20181106003259 |
| Provider Name | Glenda Pulliam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952871055 PECOS PAC ID: 4082882139 Enrollment ID: I20190215002278 |
| Provider Name | Edna Obehi Idehen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780170571 PECOS PAC ID: 7416200779 Enrollment ID: I20190522001844 |
| Provider Name | Vivian Breslin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356434955 PECOS PAC ID: 8022040732 Enrollment ID: I20190722002147 |
| Provider Name | Melanie Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992348395 PECOS PAC ID: 1254766223 Enrollment ID: I20200121002617 |
| Provider Name | Chacey Bryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699228734 PECOS PAC ID: 9234425885 Enrollment ID: I20220404001270 |
| Provider Name | Adrianna Deise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689916629 PECOS PAC ID: 9638558877 Enrollment ID: I20220709000408 |
| Provider Name | Ian Nicholas Shaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356041065 PECOS PAC ID: 3072970433 Enrollment ID: I20230531001954 |
| Provider Name | Tiffany Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417648916 PECOS PAC ID: 4688033350 Enrollment ID: I20230629000732 |
| Provider Name | Deborah Sadek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790487577 PECOS PAC ID: 5193173342 Enrollment ID: I20231128002799 |
| Provider Name | Erin Pruitt Drennon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821855602 PECOS PAC ID: 3870930993 Enrollment ID: I20240326000488 |
| Provider Name | Ma Melissa Reyes Sarmiento |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740036938 PECOS PAC ID: 6406392380 Enrollment ID: I20240726003979 |
| Provider Name | Denita Waltower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720750847 PECOS PAC ID: 7012446586 Enrollment ID: I20250129000004 |
| Provider Name | Nita Karki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932975141 PECOS PAC ID: 4183145626 Enrollment ID: I20250312003397 |
| Provider Name | Maher Elharake |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598296956 PECOS PAC ID: 4284024860 Enrollment ID: I20250826004166 |
| Provider Name | Paulette Beverly Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598099681 PECOS PAC ID: 3971095084 Enrollment ID: I20251125004500 |
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