Lifequest East Marietta LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

33753 Issued in GA

Legal business name

LIFEQUEST EAST MARIETTA LLC

Doing business as

Energy Medical Group

Practice address

4930 Davidson Rd NE
100
Marietta, GA 30068-4661

Phone

(678) 973-0635

NPI assigned

Jul 9, 2014

Last updated

Jul 9, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Broussard

Title

Vice President

Phone

(678) 973-0635

Specialties & licenses 1

Addresses

Other names 1

• Energy Medical Group Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1023424181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3362 ACWORTH SUMMIT BLVD NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015770",
            "telephone_number": "678-973-0635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 DAVIDSON RD NE",
            "address_2": "100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684661",
            "telephone_number": "678-973-0635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEQUEST EAST MARIETTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-09",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "678-973-0635"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "33753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Energy Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Clinic/Center in Marietta, GA
• Providers in Marietta, GA by specialty
• Health Service Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.