Lifeguide, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LIFEGUIDE, INC

Practice address

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

Phone

(770) 557-1079

NPI assigned

May 5, 2007

Organization subpart

No

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

Authorized official

Name

Latesha Johnson

Title

Manager

Phone

(317) 820-7582

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 2

• Lifeguide Family Practice LLC Doing business as
• Lifeguide Health Services Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Modupe Agbeyomi, DNP, FNP-C

  • Family Nurse Practitioner
  • Brookhaven, GA
  • NPI 1245715903

  Multi-Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1178323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1508078973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 FOREST PKWY",
            "address_2": "SUITE 270",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976142",
            "telephone_number": "404-363-6922",
            "fax_number": "404-363-6925"
        },
        {
            "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": [
        {
            "address_1": "519 Forest Pkwy",
            "address_2": "Suite 270",
            "address_purpose": "LOCATION",
            "city": "Forest Park",
            "state": "GA",
            "postal_code": "302976142",
            "country_code": "US",
            "telephone_number": "404-363-6922",
            "fax_number": "404-363-6925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFEGUIDE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-05",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LATESHA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "317-820-7582"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "031-R-0050",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276046116A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "838117320A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeguide Family Practice LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifeguide Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifeguide Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronald S Lev, PT
• Jenna L Levy, LMT, NMT
• Bonnie Marie Lexo-Hudson, FNP
• Lifebrite Physician Group LLC
• Lifeguide Family Practice LLC
• Lifeline Medical Center, LLC
• Lifeline Primary Care, Inc
• Gwendolyn Ann Ligon, MS
• Lilburn Acupuncture LLC
• Lilburn Community Pharmacy

• 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 May 24, 2022; 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.