Basic Information
| Provider Information | |||||||||
| NPI: | 1821361577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR CARE OFFICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 S. ENOTA DRIVE | ||||||||
| Address2: | SUITE Q | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305012240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702198420 | ||||||||
| FaxNumber: | 7702198440 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 BEVERLY ROAD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305012037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702198600 | ||||||||
| FaxNumber: | 7702198440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2012 | ||||||||
| LastUpdateDate: | 04/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | GAUR | ||||||||
| AuthorizedOfficialFirstName: | SWATI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7702198600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 057624 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.