MEDICARE: SERENITY CARE CENTER AND SPA 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1588427637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY CARE CENTER AND SPA LLC

Provider Business Mailing Address
First Line	:	3610 CHAMBLEE TUCKER RD UNIT 3610
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-4418
Country	:	US
Telephone Number	:	770-294-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 CHAMBLEE TUCKER RD UNIT 3610
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-4418
Country	:	US
Telephone Number	:	770-294-2780
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DARTAGNAN EQUESTRIAN GIBSON
Credential	:
Telephone Number	:	843-609-6169

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	04/12/2025

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