Lifesource Prime Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LIFESOURCE PRIME INC

Practice address

1345 Redmond Cir NW
Rome, GA 30165-1307

Phone

(910) 742-9243

Fax

(888) 746-1787

NPI assigned

Dec 18, 2025

Organization subpart

No

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

Authorized official

Name

Tabitha Hoffman

Title

Credentialing

Phone

(910) 777-9165

Specialties & licenses 4

Addresses

Tax ID family

Lifesource Prime Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lifesource Prime Inc

  • Family Medicine Physician
  • Richmond, VA
  • NPI 1548124159
  NPD tax ID

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

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1841155181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740343",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303740343",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 REDMOND CIR NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651307",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESOURCE PRIME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-18",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "910-777-9165"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Lewis
• Lieberman Family Chiropractic
• Brian Lieberman, D.C.
• Lifeguard Ambulance Service LLC
• Lifesource of North Carolina
• Mark Douglas Lignell, MD
• Catherine W Lin, D.O.
• Jamie O Lin, DO
• A John Linatoc, DMD, MS, PC
• Lincare Inc

• Internal Medicine Physician in Rome, GA
• Providers in Rome, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2025; 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.