Seniorwell of Georgia, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SENIORWELL OF GEORGIA, LLC

Practice address

2002 Summit Blvd Ste 300
Brookhaven, GA 30319-6422

Phone

(844) 882-3127

Fax

(844) 246-5877

NPI assigned

Feb 10, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Moroney

Title

Ceo

Phone

(844) 882-3127

Specialties & licenses 4

Addresses

Other names 1

• SeniorWell of Georgia, LLC Doing business as

Tax ID family

Seniorwell of Georgia LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Seniorwell of Georgia, LLC

  • Optometrist
  • Brookhaven, GA
  • NPI 1689206559
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581292800000",
    "number": "1629600424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD STE 1000",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "844-882-3127",
            "fax_number": "844-246-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 SUMMIT BLVD STE 300",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303196422",
            "telephone_number": "844-882-3127",
            "fax_number": "844-246-5877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIORWELL OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A",
        "authorized_official_last_name": "MORONEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "844-882-3127"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SeniorWell of Georgia, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kora Schibner, RBT
• Amber Jodene Seidel
• Virginia Crabtree Seldowitz, CCC-SLP
• Jonathan Sellers, PHARM.D.
• Ryan Semensohn, DMD, DO
• Seniorwell of Georgia, LLC
• Sensawee Play
• Michale Sferra, PHD
• Devon Thomas Shannon
• Amanda Jane Sharp, PT, DPT

• Optometrist in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.