Healthcare Provider Details

I. General information

NPI: 1134885098
Provider Name (Legal Business Name): LEMON JUICE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 02/20/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 JAMES HENRY DR
DACULA GA
30019-7553
US

IV. Provider business mailing address

2812 N DR WILLIAM FINLAYSON ST APT 506
MILWAUKEE WI
53212-2356
US

V. Phone/Fax

Practice location:
  • Phone: 678-638-9579
  • Fax:
Mailing address:
  • Phone: 678-372-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VONITA ISIDORE
Title or Position: OWNER/PROVIDER
Credential: CNA
Phone: 678-378-3119