NPIMap

Organization Active NPI

Lifeline Primary Care, Inc

  • Family Medicine Physician
  • Duluth, GA
National Provider Identifier
1104292630
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
056624 Issued in GA
Legal business name
LIFELINE PRIMARY CARE, INC
Practice address
4855 River Green Pkwy
Building 7, Suite 700
Duluth, GA 30096-8336
Phone
(678) 775-9344
NPI assigned
Aug 19, 2015
Organization subpart
Yes
Parent organization
LIFELINE PRIMARY CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Ms. Brina Lynn Rolison
Title
Business Development
Phone
(678) 775-9344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 056624 GA Primary

Addresses

Primary practice location

4855 River Green Pkwy
Building 7, Suite 700
Duluth, GA 30096-8336

Mailing address

4855 River Green Pkwy
Building 7, Suite 700
Duluth, GA 30096-8336

Other identifiers 1

IdentifierTypeStateIssuer
267992339BMedicaidGA

Other names 1

  • Lifeline Primary Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifeline Primary Care Inc4 organizations share this tax ID, including this one
Part of
Lifeline Primary Care Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1104292630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 RIVER GREEN PKWY",
            "address_2": "BUILDING 7, SUITE 700",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300968336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 RIVER GREEN PKWY",
            "address_2": "BUILDING 7, SUITE 700",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300968336",
            "telephone_number": "678-775-9344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE PRIMARY CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFELINE PRIMARY CARE, INC",
        "enumeration_date": "2015-08-19",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "ROLISON",
        "authorized_official_first_name": "BRINA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "678-775-9344",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "056624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267992339B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeline Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.