LIFE UNIVERSITY (NPI# 1902033343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902033343 |
| Entity Type | Organization |
| Organization Name | LIFE UNIVERSITY |
| Other Organization Name | LIFE FUNCTIONAL NEUROLOGY CENTER |
| Practice Address |
1269 Barclay Cir Se Marietta GA 30060-2903 |
| Mailing Address |
1415 Barclay Cir Se Marietta GA 30060-2943 |
| Practice Telephone | 7704262809 |
| Mailing Telephone | 7704262809 |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2013-02-25 |
| Authorized Official Name | DR. STEPHEN T BOLLES (ADMINISTRATIVE DIRECTOR, CLINIC) |
| Authorized Official Telephone | 6129104814 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| LIFE Functional Neurology Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700408887 | Life University | Chiropractor | 1323 Roswell Road, Marietta, GA 30062 | 2020-05-12 |
| 1063033942 | Life University | Chiropractor | 1 Baltimore P1. Nw, Suite 100, Atlanta, GA 30308 | 2020-05-01 |
| 1780082404 | Life University | Clinic/Center | 1415 Barclay Cir Se, Marietta, GA 30060-2943 | 2014-12-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | LIFE UNIVERSITY | 655 Nw 195th St, Shoreline, WA 30060-2673 |
| Street Address |
1269 BARCLAY CIR SE |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-2903 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326178294 | Peter J Wilson | Chiropractor | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2007-03-07 |
| 1720621022 | Dustin Le | Specialist/Technologist | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2019-10-20 |
| 1477039618 | Kara Lyn Sapp Sontag | Specialist/Technologist | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2018-07-11 |
| 1770017949 | Amanda Jackson | Specialist/Technologist | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2017-04-14 |
| 1851834808 | Robert Jarrod Vanatta | Specialist/Technologist | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2016-11-23 |
| 1851790018 | David Koentop | Chiropractor | 1269 Barclay Cir Se, Life University: Lussi, Marietta, GA 30060-2903 | 2014-08-13 |
| 1275803835 | Paula Rhodes | Chiropractor | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2012-01-12 |
| 1437325933 | Christopher G Markie | Specialist/Technologist | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2008-05-05 |
| 1538375514 | Frank Keith Schwitz | Chiropractor | 1269 Barclay Cir Se, Marietta, GA 30060-2903 | 2007-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295382778 | Advanced Urology Institute of Georgia | Clinic/Center | 1371 Church Street Ext Ne Ste 200, Marietta, GA 30060-7913 | 2019-08-20 |
| 1699259929 | Life Moves Manual Therapies, LLC | Clinic/Center | 1800 Roswell Rd Ste 1050, Marietta, GA 30062-3982 | 2018-09-21 |
| 1972091460 | Neuroworks Healthcare LLC | Clinic/Center | 3939 Roswell Rd Ste 240, Marietta, GA 30062-6285 | 2018-04-30 |
| 1053862169 | Regional Marietta Medical Center | Clinic/Center | 1469 Roswell Rd, Marietta, GA 30062-3668 | 2016-10-24 |
| 1821402348 | Washington County Free Clinic Inc | Clinic/Center | 208 3rd St, Marietta, OH 45750-3001 | 2014-06-12 |
| 1851638464 | L & P Services Inc | Clinic/Center | 215 Marion St, Marietta, OH 45750-1842 | 2013-01-16 |
| 1578703773 | Hyperbaric Medicine of North Atlanta | Clinic/Center | 1341 Canton Rd, Suite A, Marietta, GA 30066-6056 | 2009-02-27 |
| 1699920983 | Dr. Biggs Chiropractic, Inc. | Clinic/Center | 736 Johnson Ferry Rd., Suite -c130, Marietta, GA 30068-4233 | 2008-12-01 |
| 1538246251 | Urology Associates Surgical Center | Clinic/Center | 300 Tower Rd, Suite 150, Marietta, GA 30060 | 2006-11-01 |
| 1285727396 | The Family Health Centers of Georgia, Inc | Clinic/Center | 805 Campbell Hill St Nw, Marietta, GA 30060-1144 | 2006-10-02 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.