Provider Demographics
NPI:1245595503
Name:SERENITY LIFE WELLNESS, LLC
Entity Type:Organization
Organization Name:SERENITY LIFE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERIGN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CEESAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-257-9989
Mailing Address - Street 1:95 CLIFTWOOD DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4917
Mailing Address - Country:US
Mailing Address - Phone:404-257-9989
Mailing Address - Fax:
Practice Address - Street 1:95 CLIFTWOOD DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4917
Practice Address - Country:US
Practice Address - Phone:404-257-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty