NPIMap

Organization Active NPI

Lifetime Family Medicine,LLC

  • Family Medicine Physician
  • Dallas, GA
National Provider Identifier
1053509216
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFETIME FAMILY MEDICINE,LLC
Doing business as
Lifetime Family Medicine LLC
Practice address
7869 Villa Rica Hwy
Dallas, GA 30157-8638
Phone
(770) 459-8449
NPI assigned
Oct 11, 2007
Last updated
Mar 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lisa H Miles
Title
Practice Manager
Phone
(770) 459-8449

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X 052082 GA
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

7869 Villa Rica Hwy
Dallas, GA 30157-8638

Mailing address

7869 Villa Rica Hwy
Dallas, GA 30157-8638
Phone (770) 459-8449

Other names 1

  • Lifetime Family Medicine LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080211000608 GA Part B Supplier - Clinic/Group Practice 3577646736 Receives reassigned benefits from 14 practitioners
Practice locations: Dallas, GA; Temple, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1076786Lifetime Family Medicine7869 Villa Rica Highway, Dallas, GA 30157Certificate of waiverMar 31, 2027

National Provider Directory

National Provider Directory

Locations

7869 Villa Rica Hwy
Dallas, GA 30157
Phone (770) 456-3333

431 Sage St
Temple, GA 30179
Phone (770) 562-9007

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1369/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1053509216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7869 VILLA RICA HWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301578638",
            "telephone_number": "770-459-8449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7869 VILLA RICA HWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301578638",
            "telephone_number": "770-459-8449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME FAMILY MEDICINE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-459-8449",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "GA",
            "license": "052082",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime Family Medicine LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifetime Family Medicine LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.