Organization
LIFEGUIDE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUKAYODE AGBEYOMI (CEO)
(678) 517-7425
Entity
Organization
Contact information
Practice address
656 INDIAN TRAIL LILBURN RD NW STE 208, LILBURN, GA 30047-6872
(770) 557-1079
Mailing address
656 INDIAN TRAIL LILBURN RD NW STE 208, LILBURN, GA 30047-6872
(770) 557-1079
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QR1100X
Research Clinic/Center
—
—
Other
Enumeration date
07/29/2021
Last updated
07/29/2021
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