Provider Demographics
NPI:1265082341
Name:SERENE CONCEPTS PC
Entity type:Organization
Organization Name:SERENE CONCEPTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MFON
Authorized Official - Middle Name:MALACHY
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-506-6867
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6149
Mailing Address - Country:US
Mailing Address - Phone:248-506-6867
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 801G
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7642
Practice Address - Country:US
Practice Address - Phone:302-455-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health