Life Source, PC
Family Medicine in Holly Springs, NC. Organization (NPI-2).
NPI number1124460985
StatusActive
Last updated in NPPESJul 22, 2013
Details
- NPI
- 1124460985
- Entity type
- Organization (NPI-2)
- Legal business name
- Life Source, PC
- Organization subpart
- No
- Enumeration date
- Jul 22, 2013
- Last updated
- Jul 22, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
1108 Kentworth DrSuite 704
Holly Springs, NC 27540-3325
Phone 919-552-9952 · Fax 919-552-3062
Mailing address
1108 Kentworth DrSuite 704
Holly Springs, NC 27540-3325
Phone 919-552-9952 · Fax 919-552-3062
Authorized official
Feyisayo Adeyina
Owner
9195529952
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