Healthcare Provider Details

I. General information

NPI: 1053658740
Provider Name (Legal Business Name): SENIOR WELLNESS SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 5TH ST SUITE 200
MIAMI BEACH FL
33139-6508
US

IV. Provider business mailing address

5369 BROOKE FARM DR
DUNWOODY GA
30338-3150
US

V. Phone/Fax

Practice location:
  • Phone: 404-210-5993
  • Fax:
Mailing address:
  • Phone: 404-210-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: AVEREL SNYDER
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 404-210-5993