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NPI Code Detail

MEDICARE: XANBODY LLC

MEDICARE: XANBODY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1497548655
Entity Type Code : Organization
Provider Name (Legal Business Name) : XANBODY LLC
Provider Business Mailing Address
First Line : 4300 PACES FERRY RD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5714
Country : US
Telephone Number : 678-390-4149
Fax Number : 678-737-1729
Provider Business Practice Location Address
First Line : 4300 PACES FERRY RD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5714
Country : US
Telephone Number : 678-390-4149
Fax Number : 678-737-1729
Authorized Official
Title or Position : CEO
Name : IRENE OBIAGERI IBENYENWA
Credential : NURSE PRACTITIONERS
Telephone Number : 404-906-5056
Provider Enumeration Date : 05/28/2025
Last Update Date : 04/06/2026

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Directions to “XANBODY LLC ” Practice Location

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