| Lifesource Prime Inc | |
|
3205 Randall Pkwy Ste 105 Wilmington NC 28403-2565 | |
| (910) 742-9243 | |
| Not Available |
| Full Name | Lifesource Prime Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3205 Randall Pkwy Ste 105, Wilmington, North Carolina |
| Authorized Official Name and Position | Peggy Baddour (CEO) |
| Authorized Official Contact | 9107429243 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Prime Inc Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 338-2882 | Lifesource Prime Inc 3205 Randall Pkwy Ste 105 Wilmington NC 28403-2565 Ph: (910) 742-9243 |
| NPI Number | 1598533275 |
|---|---|
| Provider Enumeration Date | 12/13/2023 |
| Last Update Date | 12/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598533275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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