NPIMap

Organization Active NPI

Lifetime Medical Center, PC

  • Family Medicine Physician
  • Ellijay, GA
National Provider Identifier
1982933107
Registry record updated Aug 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
051241 Issued in GA
Legal business name
LIFETIME MEDICAL CENTER, PC
Practice address
14244 Highway 515 N
Suite 100
Ellijay, GA 30536
Phone
(706) 698-5433
NPI assigned
Dec 17, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2014

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

Authorized official

Name
Lee Kent
Title
Administrator
Phone
(706) 698-5433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 051241 GA Primary

Addresses

Primary practice location

14244 Highway 515 N
Suite 100
Ellijay, GA 30536

Mailing address

14244 Highway 515 N
Suite 100
Ellijay, GA 30536
Phone (706) 698-5433

Other identifiers 1

IdentifierTypeStateIssuer
202 G701 589OtherGAMEDICARE GROUP #

National Provider Directory

National Provider Directory

Locations

14244 Highway 515 N
Unit 100
Ellijay, GA 30536
Phone (404) 996-6596

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2353/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1982933107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14244 HIGHWAY 515 N",
            "address_2": "SUITE 100",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "30536",
            "telephone_number": "706-698-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14244 HIGHWAY 515 N",
            "address_2": "SUITE 100",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "30536",
            "telephone_number": "706-698-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME MEDICAL CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-698-5433"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "051241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "202 G701 589",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; 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.