Organization Active NPI

Lifeboat Medical Associates 2, LLC

  • Gynecology Physician
  • Peachtree City, GA
National Provider Identifier
1346756129
Registry record updated Dec 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
LIFEBOAT MEDICAL ASSOCIATES 2, LLC
Practice address
1201 Georgian Park
Peachtree City, GA 30269-6972
Phone
(770) 631-4873
Fax
(770) 631-0684
NPI assigned
Dec 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2017

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

Authorized official

Name
Mrs. Shelley Depp
Title
Payer Relations Liaison
Phone
(770) 579-2626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X Primary

Addresses

Primary practice location

1201 Georgian Park
Peachtree City, GA 30269-6972

Mailing address

PO Box 468329
Atlanta, GA 31146-8329
Phone (404) 943-0205

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513296000000",
    "number": "1346756129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468329",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311468329",
            "telephone_number": "404-943-0205",
            "fax_number": "404-943-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 GEORGIAN PARK",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302696972",
            "telephone_number": "770-631-4873",
            "fax_number": "770-631-0684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBOAT MEDICAL ASSOCIATES 2, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-15",
        "last_updated": "2017-12-15",
        "status": "A",
        "authorized_official_last_name": "DEPP",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "PAYER RELATIONS LIAISON",
        "authorized_official_telephone_number": "770-579-2626",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; 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.