Lifeguide Family Practice LLC – Primary Care Clinic/Center, NPI 1508078973
Primary Care Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Lifeguide Family Practice LLC
656 INDIAN TRAIL LILBURN RD NW STE 208
LILBURN, GA 300476872
Phone: (770) 557-1079
Type: Location
519, Forest Parkway, Forest Park, Clayton County, Georgia, 30297, United States
SUITE 270
FOREST PARK, GA 302976142
Phone: (404) 363-6922
Fax: (404) 363-6925
Type: Mailing
519 Forest Pkwy
Suite 270
Forest Park, GA 302976142
Phone: (404) 363-6922
Fax: (404) 363-6925
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-02-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20220217002824 | O | Clinic/Group Practice | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30047)
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