1427681816 NPI number — PRUDENT SENIOR SERVICES OF GEORGIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427681816 NPI number — PRUDENT SENIOR SERVICES OF GEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRUDENT SENIOR SERVICES OF GEORGIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427681816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3850 HOLCOMB BRIDGE RD STE 350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CORNERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30092-5292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-454-7979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3860 HOLCOMB BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEACHTREE CORNERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-454-7979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
YIN
Authorized Official First Name:
WOOIYI
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
770-612-1388

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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