| Lifesource Of Georgia | |
|
1345 Redmond Cir Nw Rome GA 30165-1307 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of Georgia |
|---|---|
| Speciality | General Practice |
| Location | 1345 Redmond Cir Nw, Rome, Georgia |
| Authorized Official Name and Position | Peggy L Baddour (PRESIDENT) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of Georgia Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 535-1211 | Lifesource Of Georgia 1345 Redmond Cir Nw Rome GA 30165-1307 Ph: (910) 742-9243 |
| NPI Number | 1962940817 |
|---|---|
| Provider Enumeration Date | 02/10/2017 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20170418000863 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962940817 | NPI | - | NPPES |
| Provider Name | Sara C Shropshire |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245298462 PECOS PAC ID: 0547223810 Enrollment ID: I20041108000642 |
| Provider Name | Susan A Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982631040 PECOS PAC ID: 8820044829 Enrollment ID: I20050323000389 |
| Provider Name | Phyllis J Jeter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437100484 PECOS PAC ID: 6901816743 Enrollment ID: I20060425000215 |
| Provider Name | William E Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871567693 PECOS PAC ID: 6608970645 Enrollment ID: I20070330000139 |
| Provider Name | Barbara W Lathrop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376734533 PECOS PAC ID: 1153401666 Enrollment ID: I20080109000239 |
| Provider Name | Henriette Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679683924 PECOS PAC ID: 8224108089 Enrollment ID: I20080605000198 |
| Provider Name | Tresselyn Douglas Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104051168 PECOS PAC ID: 9234274531 Enrollment ID: I20100310000657 |
| Provider Name | Sonali Bora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831375682 PECOS PAC ID: 8426235706 Enrollment ID: I20110614000710 |
| Provider Name | Raquel Nmi Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568516839 PECOS PAC ID: 4688839111 Enrollment ID: I20120706000160 |
| Provider Name | Willie James Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417217092 PECOS PAC ID: 1456500545 Enrollment ID: I20121004000749 |
| Provider Name | Joseph P Mcevoy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962586859 PECOS PAC ID: 0547364879 Enrollment ID: I20130729000484 |
| Provider Name | Christopher M Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821140237 PECOS PAC ID: 5193890143 Enrollment ID: I20140808001252 |
| Provider Name | Kimberly Perkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306171129 PECOS PAC ID: 2163643925 Enrollment ID: I20141020000836 |
| Provider Name | Catherine L Hoover |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376893131 PECOS PAC ID: 3476855842 Enrollment ID: I20160104000162 |
| Provider Name | Christina Haire |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366800013 PECOS PAC ID: 2365747193 Enrollment ID: I20160216001979 |
| Provider Name | Maureen N Ogbu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770943185 PECOS PAC ID: 8729384581 Enrollment ID: I20160304001544 |
| Provider Name | Cathleen Ann Hulbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205297090 PECOS PAC ID: 6709182074 Enrollment ID: I20160311002136 |
| Provider Name | Maureen D Kapatkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740381458 PECOS PAC ID: 4385706506 Enrollment ID: I20161031001938 |
| Provider Name | Ablavi A Agomessou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164885778 PECOS PAC ID: 4385926112 Enrollment ID: I20170131000635 |
| Provider Name | Lisa Rasheed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538371687 PECOS PAC ID: 7911276464 Enrollment ID: I20170627001802 |
| Provider Name | Susan Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588968150 PECOS PAC ID: 3678849429 Enrollment ID: I20171023000451 |
| Provider Name | Chidimma Nzoiwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396262812 PECOS PAC ID: 4587929906 Enrollment ID: I20180605002063 |
| Provider Name | Salim Elhalaby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750658662 PECOS PAC ID: 9436414067 Enrollment ID: I20180608001623 |
| Provider Name | Barbara Joan Rubin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669801551 PECOS PAC ID: 7911241179 Enrollment ID: I20181129001675 |
| Provider Name | Latosha Meshun Howard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770051088 PECOS PAC ID: 9133463284 Enrollment ID: I20181130001617 |
| Provider Name | Breonna D Leon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225508542 PECOS PAC ID: 7911245204 Enrollment ID: I20190212001433 |
| Provider Name | Tyshawn Kingsberry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932297652 PECOS PAC ID: 6305186933 Enrollment ID: I20190319001056 |
| Provider Name | Robert H Connell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538106869 PECOS PAC ID: 6800138843 Enrollment ID: I20190423002719 |
| Provider Name | Esther Jean-gratia |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437612322 PECOS PAC ID: 3577896000 Enrollment ID: I20190614001139 |
| Provider Name | Hassan Ayaz Bokhari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811158082 PECOS PAC ID: 2062653462 Enrollment ID: I20190723001567 |
| Provider Name | Ephi J Betan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114483534 PECOS PAC ID: 0244566248 Enrollment ID: I20190730000510 |
| Provider Name | Austina Mercy Njoku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942783477 PECOS PAC ID: 9234460007 Enrollment ID: I20191008004003 |
| Provider Name | Terri Nabritt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952891889 PECOS PAC ID: 1951632348 Enrollment ID: I20191016002151 |
| Provider Name | Shola Adewunmi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073168449 PECOS PAC ID: 4082946074 Enrollment ID: I20191023003551 |
| Provider Name | Alisha Polite |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811328347 PECOS PAC ID: 3375971609 Enrollment ID: I20200319000864 |
| Provider Name | Ebote Ngite Nnoko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346871696 PECOS PAC ID: 0547699662 Enrollment ID: I20200410000197 |
| Provider Name | Beatrice Odero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194358754 PECOS PAC ID: 9436571130 Enrollment ID: I20200625003157 |
| Provider Name | Simon Njelefack Ekokobe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093345373 PECOS PAC ID: 4688099955 Enrollment ID: I20200803003400 |
| Provider Name | Rebecca Nicole Williford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316585185 PECOS PAC ID: 1153740972 Enrollment ID: I20200929000825 |
| Provider Name | Destin Stewart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033545785 PECOS PAC ID: 1355755943 Enrollment ID: I20210121002097 |
| Provider Name | Shanae Mapp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023532231 PECOS PAC ID: 1557778057 Enrollment ID: I20210330000980 |
| Provider Name | Carlene Mceachron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134594351 PECOS PAC ID: 7113335167 Enrollment ID: I20210413000656 |
| Provider Name | Kenisha Hardy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659759546 PECOS PAC ID: 6901209931 Enrollment ID: I20210728000681 |
| Provider Name | Jana Erika Cua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225491087 PECOS PAC ID: 6608160635 Enrollment ID: I20210917000281 |
| Provider Name | Michelle Meadows |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962121988 PECOS PAC ID: 5890179527 Enrollment ID: I20220830002954 |
| Provider Name | Krystal Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346988441 PECOS PAC ID: 7719353473 Enrollment ID: I20221020001537 |
| Provider Name | Laura Swails |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558099572 PECOS PAC ID: 2264809698 Enrollment ID: I20221027002299 |
| Provider Name | Jeronia Bowden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790248771 PECOS PAC ID: 8022485515 Enrollment ID: I20221114001976 |
| Provider Name | Sebrina Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285266734 PECOS PAC ID: 1658741376 Enrollment ID: I20221221000899 |
| Provider Name | Linda Udeani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780394981 PECOS PAC ID: 4688044845 Enrollment ID: I20230104000690 |
| Provider Name | Chanel M Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922776087 PECOS PAC ID: 9739577263 Enrollment ID: I20230301000677 |
| Provider Name | Angel Lynett Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801253604 PECOS PAC ID: 6103291174 Enrollment ID: I20230404002174 |
| Provider Name | Aminata Barrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053035725 PECOS PAC ID: 1052786928 Enrollment ID: I20230406000138 |
| Provider Name | Kayla Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023701307 PECOS PAC ID: 9931569357 Enrollment ID: I20230718000251 |
| Provider Name | Zachary Blaine Stroud |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548427370 PECOS PAC ID: 9739373432 Enrollment ID: I20230726000713 |
| Provider Name | Gail Simpson Bleichner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629853726 PECOS PAC ID: 0244684801 Enrollment ID: I20230929003417 |
| Provider Name | Margaret Gray Marger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982394516 PECOS PAC ID: 0042665507 Enrollment ID: I20231018002711 |
| Provider Name | Asma Khawaja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578252391 PECOS PAC ID: 6709232630 Enrollment ID: I20231027002178 |
| Provider Name | Angelia Holland-dunning |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669747267 PECOS PAC ID: 6204282072 Enrollment ID: I20231031000667 |
| Provider Name | Jennie Evans |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720629298 PECOS PAC ID: 8820448871 Enrollment ID: I20240103001528 |
| Provider Name | Sunari Cody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871017525 PECOS PAC ID: 2769833722 Enrollment ID: I20240104000766 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20240118000977 |
| Provider Name | Tameca Reed |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194307637 PECOS PAC ID: 8729430137 Enrollment ID: I20240122003697 |
| Provider Name | Anuli Okolo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598541567 PECOS PAC ID: 3577916873 Enrollment ID: I20240201003534 |
| Provider Name | Rebecca Lawrence |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144248360 PECOS PAC ID: 4880691476 Enrollment ID: I20240319000518 |
| Provider Name | Larry Dale Deyton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063554913 PECOS PAC ID: 5890135610 Enrollment ID: I20240426002425 |
| Provider Name | Precious Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235620527 PECOS PAC ID: 5890117287 Enrollment ID: I20240430003674 |
| Provider Name | Carlotta Z Hudson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295487510 PECOS PAC ID: 9739521758 Enrollment ID: I20240522002575 |
| Provider Name | Dehia Graham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376082800 PECOS PAC ID: 6507308459 Enrollment ID: I20240606001290 |
Highland Rivers Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 96 Alford Rd Se, Rome, GA 30161 Phone: 706-270-5033 Fax: 706-370-7749 | |
Atrium Health Floyd Medical Center Behavioral Health Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 306 Shorter Ave Nw, Rome, GA 30165 Phone: 706-509-3500 Fax: 706-509-4791 | |
Balanced Living Counseling Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 412 E 1st St, Rome, GA 30161 Phone: 706-509-0130 Fax: 706-237-6503 | |
Behavior Momentum Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 113 Acadia Dr Nw, Rome, GA 30165 Phone: 706-676-6689 | |
New Horizons Treatment Center Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 36 Chateau Ct Se, Rome, GA 30161 Phone: 706-233-9603 Fax: 706-233-9526 | |
Redmond Hospital Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Redmond Rd Nw, Rome, GA 30165 Phone: 706-734-7643 Fax: 706-734-7356 | |
Lavender Mountain Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 111 Bridgepoint Plz Ste 120, Rome, GA 30161 Phone: 706-450-4029 Fax: 706-810-4029 |