=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932521903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR CITIZEN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2014
-----------------------------------------------------
Last Update Date | 01/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1705 COMMERCE DR NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-351-3889
-----------------------------------------------------
Fax | 404-352-0595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1705 COMMERCE DR NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-351-3889
-----------------------------------------------------
Fax | 404-352-0595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JEFFERY SMYTHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-351-3889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number | 002648LEX
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------