Organization
SERENITY4LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA SHAW (OWNER)
(678) 540-1009
Entity
Organization
Contact information
Practice address
2316 DEER SPRINGS DR, ELLENWOOD, GA 30294-1168
(404) 391-7200
Mailing address
2316 DEER SPRINGS DR, ELLENWOOD, GA 30294-1168
(678) 540-1009
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
10/27/2022
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