Provider Demographics
NPI:1629767587
Name:SENIORS FIRST OF GEORGIA LLC
Entity Type:Organization
Organization Name:SENIORS FIRST OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-615-0105
Mailing Address - Street 1:2295 PARKLAKE DR NE STE 360
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2943
Mailing Address - Country:US
Mailing Address - Phone:470-545-2295
Mailing Address - Fax:
Practice Address - Street 1:2295 PARKLAKE DR NE STE 360
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2943
Practice Address - Country:US
Practice Address - Phone:470-545-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care