Healthcare Provider Details

I. General information

NPI: 1245595503
Provider Name (Legal Business Name): SERENITY LIFE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CLIFTWOOD DR NE SUITE A
ATLANTA GA
30328-4917
US

IV. Provider business mailing address

95 CLIFTWOOD DR NE SUITE A
ATLANTA GA
30328-4917
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-9989
  • Fax:
Mailing address:
  • Phone: 404-257-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. SERIGN J CEESAY
Title or Position: CEO
Credential:
Phone: 404-257-9989