Provider Demographics
NPI:1265480743
Name:SERENITY BY ANNETTE INC
Entity Type:Organization
Organization Name:SERENITY BY ANNETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:GUSSIE
Authorized Official - Last Name:BYMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-508-0664
Mailing Address - Street 1:118 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-8407
Mailing Address - Country:US
Mailing Address - Phone:678-508-0664
Mailing Address - Fax:
Practice Address - Street 1:118 NORTH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-8405
Practice Address - Country:US
Practice Address - Phone:678-508-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies