Provider Demographics
NPI:1295408763
Name:LIFEGUIDE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:LIFEGUIDE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUKAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBEYOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-517-7425
Mailing Address - Street 1:656 INDIAN TRAIL LILBURN RD NW STE 208
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6872
Mailing Address - Country:US
Mailing Address - Phone:770-557-1079
Mailing Address - Fax:
Practice Address - Street 1:656 INDIAN TRAIL LILBURN RD NW STE 208
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6872
Practice Address - Country:US
Practice Address - Phone:770-557-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch