Provider Demographics
NPI:1083293070
Name:LIFE ESSENTIAL RESOURCES
Entity Type:Organization
Organization Name:LIFE ESSENTIAL RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHADEESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-452-8648
Mailing Address - Street 1:2115 CREST WOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4786
Mailing Address - Country:US
Mailing Address - Phone:404-452-8648
Mailing Address - Fax:
Practice Address - Street 1:2115 CREST WOOD DR
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4786
Practice Address - Country:US
Practice Address - Phone:404-452-8648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251J00000XAgenciesNursing Care