Healthcare Provider Details

I. General information

NPI: 1235727603
Provider Name (Legal Business Name): SENIOR WISDOM PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2021
Last Update Date: 01/01/2021
Certification Date: 01/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 JIMMY CARTER BLVD
NORCROSS GA
30093-3641
US

IV. Provider business mailing address

4845 JIMMY CARTER BLVD
NORCROSS GA
30093-3641
US

V. Phone/Fax

Practice location:
  • Phone: 678-825-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PRISCILLA BEYNE
Title or Position: COO
Credential:
Phone: 404-680-9978