Provider Demographics
NPI:1497548655
Name:XANBODY LLC
Entity type:Organization
Organization Name:XANBODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:IBENYENWA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-405-2424
Mailing Address - Street 1:1350 WOOTEN LAKE RD NW STE 204
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1346
Mailing Address - Country:US
Mailing Address - Phone:678-402-1389
Mailing Address - Fax:
Practice Address - Street 1:1350 WOOTEN LAKE RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1344
Practice Address - Country:US
Practice Address - Phone:678-402-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service