NPIMap

Organization Active NPI

Life Clinic of Ga PC

  • Chiropractor
  • Woodstock, GA
National Provider Identifier
1922752807
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
LIFE CLINIC OF GA PC
Practice address
14200 Highway 92
Woodstock, GA 30188-7139
Phone
(952) 229-7464
NPI assigned
Feb 9, 2022
Last updated
Feb 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Reza AlizadehNPI 1538214598
Title
President
Phone
(612) 868-6894

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

14200 Highway 92
Woodstock, GA 30188-7139

Mailing address

PO Box 549
Chanhassen, MN 55317-0549

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220509000649 GA Part B Supplier - Clinic/Group Practice 5395122675 Receives reassigned benefits from 6 practitioners
Practice locations: Woodstock, GA; Sandy Springs, GA; Atlanta, GA; Alpharetta, GA; Johns Creek, GA

National Provider Directory

National Provider Directory

Locations

855 North Point Pkwy
Alpharetta, GA 30005
Phone (952) 401-2336

3470 Peachtree Rd NE
Atlanta, GA 30326
Phone (404) 965-7558

5600 Roswell Rd
Sandy Springs, GA 30342

Practitioners & affiliated clinicians

Practitioners 101

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 101

NPI Registry JSON

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1922752807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553170549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14200 HIGHWAY 92",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301887139",
            "telephone_number": "952-229-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC OF GA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "ALIZADEH",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-868-6894"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.