Healthcare Provider Details

I. General information

NPI: 1679217426
Provider Name (Legal Business Name): SEMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 ROSWELL RD STE 120
ATLANTA GA
30342-2205
US

IV. Provider business mailing address

5009 ROSWELL RD STE 120
ATLANTA GA
30342-2205
US

V. Phone/Fax

Practice location:
  • Phone: 470-814-4263
  • Fax: 404-266-2294
Mailing address:
  • Phone: 470-814-4263
  • Fax: 404-266-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY L PRIDGEN
Title or Position: MANAGINGMEMBER/CLINICAL COORDINATOR
Credential:
Phone: 470-418-4263