Healthcare Provider Details

I. General information

NPI: 1427681816
Provider Name (Legal Business Name): PRUDENT SENIOR SERVICES OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 HOLCOMB BRIDGE RD
PEACHTREE CORNERS GA
30092
US

IV. Provider business mailing address

3850 HOLCOMB BRIDGE RD STE 350
PEACHTREE CORNERS GA
30092-5292
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-7979
  • Fax:
Mailing address:
  • Phone: 770-454-7979
  • 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: WOOIYI YIN
Title or Position: SECRETARY
Credential:
Phone: 770-612-1388