LIFEGUIDE HEALTH SERVICES
NPI 1508078973
Clinic/Center - Primary Care in Lilburn, GA
About Lifeguide Health Services NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LIFEGUIDE HEALTH SERVICES (NPI 1508078973) is a healthcare organization registered as a primary care in Lilburn, Georgia and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through October 30, 2027, maintains a secondary practice location in Forest Park, and lists Latesha Johnson, Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 2
Secondary Practice Location 1
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lifeguide Health Services is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lifeguide Health Services, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2209606
Lifeguide Healthcare · Sandy Springs, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lifeguide, Inc's NPI number?
The NPI number for Lifeguide, Inc is 1508078973. It was assigned to this organization in the NPPES registry on May 5, 2007. The provider is doing business as Lifeguide Health Services and Lifeguide Family Practice LLC.
Where is Lifeguide, Inc located?
Lifeguide, Inc is located at 656 Indian Trail Lilburn Rd NW Ste 208, Lilburn, GA 30047. The listed phone number is (770) 557-1079.
What is Lifeguide, Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Lifeguide, Inc enrolled in Medicare?
Yes. Lifeguide, Inc is registered in the Medicare PECOS enrollment system.
When is Lifeguide, Inc's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Georgia, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lifeguide, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Lifeguide, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lifeguide, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2209606) is associated with this NPI, valid through October 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Lifeguide, Inc was last updated on May 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lifeguide Health Services · NPI 1508078973
Primary Care organization in Lilburn, Georgia. Organization record, active in the CMS NPPES registry since May 5, 2007.
## Identity
- **NPI:** 1508078973 (Entity type: Organization)
- **Enumerated:** May 5, 2007
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Legal business name:** Lifeguide, Inc
- **Also known as:** Lifeguide Family Practice LLC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Latesha Johnson, MANAGER
## Practice location
- **Address:** 656 INDIAN TRAIL LILBURN RD NW STE 208, Lilburn, GA 30047-6872
- **Phone:** (770) 557-1079
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Georgia, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 24, 2022
- **Other identifiers:** Medicaid 276046116A (GA); Medicaid 838117320A (GA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1508078973) · Data from the CMS NPPES public registry.