Organization
LIFEGUIDE, INC
Active
Other names
Lifeguide Health Services, Lifeguide Family Practice LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LATESHA JOHNSON (MANAGER)
(317) 820-7582
Entity
Organization
Contact information
Practice address
656 INDIAN TRAIL LILBURN RD NW STE 208, LILBURN, GA 30047-6872
(770) 557-1079
Mailing address
519 FOREST PKWY, SUITE 270, FOREST PARK, GA 30297-6142
(404) 363-6922
(404) 363-6925
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
031-R-0050
GA
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276046116A
—
GA
05
—
838117320A
—
GA
Enumeration date
05/05/2007
Last updated
05/24/2022
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