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General NPI Number Information
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NPI Number | 1679960884
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Entity Type | Organization
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Legal Business Name | ALLYS SERNIOR SERVICES, INC.
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Dates
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Enumeration Date | 04/26/2015
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Last Update Date | 04/26/2015
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Provider Practice Location Address
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Address Line | 3400 MCCLURE BRIDGE RD BUILDING C-301
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City | DULUTH
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State | GA
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Zip | 30096-6675
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Country | US
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Telephone | 404-839-3631
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 MCCLURE BRIDGE RD BUILDING C-301
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City | DULUTH
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State | GA
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Zip | 30096-6675
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Country | US
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Telephone | 404-839-3631
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MARGUERITA B. PARKER
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Credential |
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Telephone | 404-839-3631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LPN067457
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License Number State | GA
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