NPIMap

Organization Active NPI

Life Healing Center PC

  • Psychiatry Physician
  • Snellville, GA
National Provider Identifier
1104149160
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
061687 Issued in GA
Legal business name
LIFE HEALING CENTER PC
Practice address
2160 Fountain Dr
Snellville, GA 30078-7022
Phone
(678) 344-8268
Fax
(888) 627-6444
NPI assigned
Mar 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Muhammad Ahmed, MDNPI 1043302037
Title
Owner
Phone
(678) 344-8268

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 061687 GA Primary

Addresses

Primary practice location

2160 Fountain Dr
Snellville, GA 30078-7022

Mailing address

2160 Fountain Dr Ste 100
Snellville, GA 30078-7022
Phone (678) 344-8268

Other practice location 1

500 Plantation Park Dr
Loganville, GA 30052-4144
Phone (678) 344-8268

Other practice location 2

1637 Athens Hwy Ste A
Grayson, GA 30017-1768
Phone (678) 733-2656

Other identifiers 2

IdentifierTypeStateIssuer
1043302037OtherINDIVIDUAL NPI
985642402AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100917000834 GA Part B Supplier - Clinic/Group Practice 9638294309 Receives reassigned benefits from 2 practitioners
Practice locations: Grayson, GA

National Provider Directory

National Provider Directory

Locations

2160 Fountain Dr
Ste C
Snellville, GA 30078
Phone (678) 344-8268

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1104149160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR STE 100",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "678-344-8268",
            "fax_number": "888-627-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "678-344-8268",
            "fax_number": "888-627-6444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Plantation Park Dr",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300524144",
            "country_code": "US",
            "telephone_number": "678-344-8268",
            "fax_number": "888-627-6444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1637 Athens Hwy Ste A",
            "address_purpose": "LOCATION",
            "city": "Grayson",
            "state": "GA",
            "postal_code": "300171768",
            "country_code": "US",
            "telephone_number": "678-733-2656",
            "fax_number": "888-627-6444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE HEALING CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-04",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-344-8268",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "061687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1043302037",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "985642402A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.