Healthcare Provider Details

I. General information

NPI: 1356340996
Provider Name (Legal Business Name): SENIOR HEALTH CONSULTING ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OCMULGEE SPRINGS DR
MACON GA
31211-6353
US

IV. Provider business mailing address

101 OCMULGEE SPRINGS DR
MACON GA
31211-6353
US

V. Phone/Fax

Practice location:
  • Phone: 478-731-2185
  • Fax: 478-745-3264
Mailing address:
  • Phone: 478-731-2185
  • Fax: 478-745-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number050236
License Number StateGA

VIII. Authorized Official

Name: CURT MASSEY
Title or Position: MEMBER
Credential:
Phone: 478-731-2185