Lifesource Prime INC

NPI #1841155181 in Rome, Georgia

Provider Information

NPI Number: 1841155181
Entity Type: Organization
Organization Name: Lifesource Prime INC
Primary Specialty: Internal Medicine
Enumeration Date: Dec 18, 2025
Last Updated: Dec 18, 2025

Practice Location

Address: 1345 REDMOND CIR NW
City: Rome
State: Georgia
ZIP Code: 30165-1307
Phone: (910) 742-9243

Authorized Official

Name: TABITHA HOFFMAN
Title: CREDENTIALING
Phone: (910) 777-9165

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Internal Medicine	207R00000X	Primary

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