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NPI Code Detail

MEDICARE: SENIORWELL POD GEORGIA, LLC

MEDICARE: SENIORWELL POD GEORGIA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist

General Provider Information

NPI Number : 1497387369
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIORWELL POD GEORGIA, LLC
Provider Business Mailing Address
First Line : 2100 E LAKE COOK RD STE 1000
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-1999
Country : US
Telephone Number : 844-882-3127
Fax Number : 844-246-5877
Provider Business Practice Location Address
First Line : 3348 PEACHTREE RD NE STE 700
Second Line :
City : ATLANTA
State : GA
Zip : 30326-1682
Country : US
Telephone Number : 844-882-3127
Fax Number : 844-246-5877
Authorized Official
Title or Position : CEO
Name : JOHN MORONEY
Credential :
Telephone Number : 844-882-3127
Provider Enumeration Date : 02/10/2020
Last Update Date : 02/10/2020

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