NPIMap

Organization Active NPI

Life Source, PC

  • Family Medicine Physician
  • Holly Springs, NC
National Provider Identifier
1124460985
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFE SOURCE, PC
Practice address
1108 Kentworth Dr
Suite 704
Holly Springs, NC 27540-3325
Phone
(919) 552-9952
Fax
(919) 552-3062
NPI assigned
Jul 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Authorized official

Name
Feyisayo Adeyina, MD
Title
Owner
Phone
(919) 552-9952

Specialties & licenses 1

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

Addresses

Primary practice location

1108 Kentworth Dr
Suite 704
Holly Springs, NC 27540-3325

Mailing address

1108 Kentworth Dr
Suite 704
Holly Springs, NC 27540-3325
Phone (919) 552-9952

National Provider Directory

National Provider Directory

Locations

1108 Kentworth Dr
Ste 704
Holly Springs, NC 27540
Phone (919) 552-9952

Practitioners & affiliated clinicians

Practitioners 1

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": "1374451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1124460985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 KENTWORTH DR",
            "address_2": "SUITE 704",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275403325",
            "telephone_number": "919-552-9952",
            "fax_number": "919-552-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 KENTWORTH DR",
            "address_2": "SUITE 704",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275403325",
            "telephone_number": "919-552-9952",
            "fax_number": "919-552-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-22",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "ADEYINA",
        "authorized_official_first_name": "FEYISAYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-552-9952",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holly Springs, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; 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.