Provider Demographics
NPI:1497387369
Name:SENIORWELL POD GEORGIA, LLC
Entity Type:Organization
Organization Name:SENIORWELL POD GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-882-3127
Mailing Address - Street 1:2100 E LAKE COOK RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1999
Mailing Address - Country:US
Mailing Address - Phone:844-882-3127
Mailing Address - Fax:844-246-5877
Practice Address - Street 1:3348 PEACHTREE RD NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1682
Practice Address - Country:US
Practice Address - Phone:844-882-3127
Practice Address - Fax:844-246-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty