Lifequest Kennesaw, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

33753 Issued in GA

Legal business name

LIFEQUEST KENNESAW, LLC

Doing business as

Energy Medical Group

Practice address

3362 Acworth Summit Blvd NW
Acworth, GA 30101-5770

Phone

(678) 973-0635

NPI assigned

Jul 8, 2014

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

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1992111280",
    "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": "3362 ACWORTH SUMMIT BLVD NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015770",
            "telephone_number": "678-973-0635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEQUEST KENNESAW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-08",
        "last_updated": "2014-09-12",
        "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"
        }
    ]
}

• Lena Lewis
• Victoria C Lewis, M.A., BCBA
• Cindy Liberal, APRN
• Philip A Librone, D.C.
• Life Jet LLC
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• Denny Yong Lim, DDS
• Limitless Ameen, LLC
• Amber Layne Lindemann, RN
• Mark A Lipschitz, D.C.

• Health Service Clinic/Center in Acworth, GA
• Providers in Acworth, 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 Sep 12, 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.