Healthcare Provider Details

I. General information

NPI: 1427769405
Provider Name (Legal Business Name): LEMON JUICE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 JAMES HENRY DR
DACULA GA
30019-7553
US

IV. Provider business mailing address

2817 JAMES HENRY DR
DACULA GA
30019-7553
US

V. Phone/Fax

Practice location:
  • Phone: 404-452-6450
  • Fax:
Mailing address:
  • Phone: 404-452-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VONITA ISIDORE
Title or Position: CNA
Credential:
Phone: 678-372-3119