National Provider Identifier Database

LIFESOURCE OF NORTH CAROLINA
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

LIFESOURCE OF NORTH CAROLINA
939 SPRINGDALE DR
CLINTON, SC29325-7266
Phone: 910-742-9243
Fax:
Website:
Specialty Taxonomy Code
* General Practice 208D00000X
Clinical 103TC0700X
Clinical 1041C0700X
Family Medicine 207Q00000X
Nurse Practitioner 363L00000X
Physician Assistant 363A00000X
Psychiatry 2084P0800X

* Indicates primary specialty

NPI Profile & details for LIFESOURCE OF NORTH CAROLINA

NPI Number 1972861789
Legal business name
LBN
LIFESOURCE OF NORTH CAROLINA
Authorized official PEGGY BADDOUR - (PRESIDENT/OWNER)
Entity Organization
Organization subpart No
Enumeration date 04/30/2012
Last updated 05/17/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers
  • SC Medicaid: GP5917

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for LIFESOURCE OF NORTH CAROLINA

There are currently no reviews for LIFESOURCE OF NORTH CAROLINA


NPIdb - Home
v2.201