Healthcare Provider Details

I. General information

NPI: 1114846326
Provider Name (Legal Business Name): THE LISA LEGACY GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N UNIVERSITY DR STE 104
CORAL SPRINGS FL
33067-4636
US

IV. Provider business mailing address

5401 N UNIVERSITY DR STE 104
CORAL SPRINGS FL
33067-4636
US

V. Phone/Fax

Practice location:
  • Phone: 954-802-6034
  • Fax:
Mailing address:
  • Phone: 954-802-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENDALL MARCUS GRIFFITH
Title or Position: PRESIDENT
Credential: MD
Phone: 954-802-6034