Lifeguide Family Practice LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LIFEGUIDE FAMILY PRACTICE LLC

Practice address

656 Indian Trail Lilburn Rd NW Ste 208
Lilburn, GA 30047-6872

Phone

(770) 557-1079

NPI assigned

Jul 29, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Olukayode Agbeyomi

Title

Ceo

Phone

(678) 517-7425

Specialties & licenses 6

Addresses

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1295408763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 INDIAN TRAIL LILBURN RD NW STE 208",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300476872",
            "telephone_number": "770-557-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 INDIAN TRAIL LILBURN RD NW STE 208",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300476872",
            "telephone_number": "770-557-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEGUIDE FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-06-17",
        "status": "A",
        "authorized_official_last_name": "AGBEYOMI",
        "authorized_official_first_name": "OLUKAYODE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-517-7425",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; 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.