Provider Demographics
NPI:1700154119
Name:SENIOR CITIZEN SERVICES OF METROPOLITAN ATLANTA
Entity type:Organization
Organization Name:SENIOR CITIZEN SERVICES OF METROPOLITAN ATLANTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:404-351-3889
Mailing Address - Street 1:1705 COMMERCE DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3107
Mailing Address - Country:US
Mailing Address - Phone:404-351-3889
Mailing Address - Fax:404-352-0595
Practice Address - Street 1:1705 COMMERCE DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3107
Practice Address - Country:US
Practice Address - Phone:404-351-3889
Practice Address - Fax:404-352-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAH701899261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA969638440AMedicaid