Healthcare Provider Details

I. General information

NPI: 1073988408
Provider Name (Legal Business Name): DIAMOND SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 NEW PEACHTREE RD SUITE 122
ATLANTA GA
30341-2543
US

IV. Provider business mailing address

5522 NEW PEACHTREE RD SUITE 122
ATLANTA GA
30341-2543
US

V. Phone/Fax

Practice location:
  • Phone: 770-612-1388
  • Fax:
Mailing address:
  • Phone: 770-612-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YEN C JAN
Title or Position: CEO
Credential:
Phone: 770-612-1388