Healthcare Provider Details

I. General information

NPI: 1518976554
Provider Name (Legal Business Name): BIOSERENITY USA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 HEMLOCK ST SUITE C
MACON GA
31201
US

IV. Provider business mailing address

99 ROSEWOOD DR STE 245
DANVERS MA
01923-4537
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-9050
  • Fax: 478-745-5125
Mailing address:
  • Phone: 978-536-7400
  • Fax: 978-536-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANICE SHOCK
Title or Position: EVP CLINICAL OPERATIONS
Credential:
Phone: 214-532-3757