LIFELINE PRIMARY CARE INC NPI 1104292630

NPI Information

  • NPI: 1104292630
  • Provider Name: LIFELINE PRIMARY CARE, INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: LIFELINE PRIMARY CARE
  • CLIA Number: 11D2266770
  • Address: 4855 RIVER GREEN PKWY
    BUILDING 7, SUITE 700
    DULUTH, GA
    ZIP 30096
  • Phone: (678) 775-9344

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NPI Details

LIFELINE PRIMARY CARE, INC is a family medicine in Duluth, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LIFELINE PRIMARY CARE, INC NPI is 1104292630. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Lifeline Primary Care.

The provider's business location address is:

4855 RIVER GREEN PKWY
BUILDING 7, SUITE 700
DULUTH, GA
ZIP 30096-336
Phone: (678) 775-9344

The provider's authorized official is Brina Lynn Rolison .
The authorized official title is Business Development and has the following contact phone number (678) 775-9344.

The CLIA number assigned to this NPI record is 11D2266770 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/19/2015 and was last updated on 8/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine056624GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1267992339BMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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