Healthcare Provider Details

I. General information

NPI: 1275468563
Provider Name (Legal Business Name): AGING WELL SENIOR COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3664 RIVER RIDGE CT
DECATUR GA
30034-4797
US

IV. Provider business mailing address

3664 RIVER RIDGE CT
DECATUR GA
30034-4797
US

V. Phone/Fax

Practice location:
  • Phone: 404-408-1428
  • Fax:
Mailing address:
  • Phone: 404-408-1428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: HATTIE M LEMON
Title or Position: SENIOR LIFE ENRICHMENT SPECIALIST
Credential:
Phone: 404-408-1428