Healthcare Provider Details

I. General information

NPI: 1700154119
Provider Name (Legal Business Name): SENIOR CITIZEN SERVICES OF METROPOLITAN ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 COMMERCE DR NW
ATLANTA GA
30318-3107
US

IV. Provider business mailing address

1705 COMMERCE DR NW
ATLANTA GA
30318-3107
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-3889
  • Fax: 404-352-0595
Mailing address:
  • Phone: 404-351-3889
  • Fax: 404-352-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberH701899
License Number StateGA

VIII. Authorized Official

Name: MR. JEFF SMYTHE
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential: MPA
Phone: 404-351-3889