Renew and Live, LLC

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

Legal business name

RENEW AND LIVE, LLC

Practice address

438 Grayson Pkwy
Grayson, GA 30017-1219

Phone

(404) 396-4417

NPI assigned

Jan 23, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa Rochelle Graham, RN, BSN, CDENPI 1699790253

Title

Owner/Program Coordinator

Phone

(404) 396-4417

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Rochelle Graham, RN, BSN, CDE

  • Nutrition Education Nutritionist
  • Lawrenceville, GA
  • NPI 1699790253
  NPD Authorized official

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516665600000",
    "number": "1033617261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 OAK RD UNIT 1541",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300781914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 GRAYSON PKWY",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300171219",
            "telephone_number": "404-396-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW AND LIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-01-23",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ROCHELLE",
        "authorized_official_title_or_position": "OWNER/PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "404-396-4417",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN, CDE"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diabetes Educator Registered Nurse in Grayson, GA
• Providers in Grayson, GA by specialty
• Diabetes Educator Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.