MEDICARE: SERENITY MEDICAL, 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326017021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY MEDICAL, LLC

Provider Business Mailing Address
First Line	:	1198 BUCKHEAD XING
Second Line	:	SUITE B
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4257
Country	:	US
Telephone Number	:	770-591-0704
Fax Number	:	770-591-9433

Provider Business Practice Location Address
First Line	:	1198 BUCKHEAD XING
Second Line	:	SUITE B
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4257
Country	:	US
Telephone Number	:	770-591-0704
Fax Number	:	770-591-9433

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PATRICK KNIERY
Credential	:
Telephone Number	:	770-591-0704

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	03/30/2010

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