1801947866 NPI number — NEW BEGINNING THERAPEUTIC SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801947866 NPI number — NEW BEGINNING THERAPEUTIC SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEGINNING THERAPEUTIC SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801947866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 SAMMY MCGHEE BLVD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30143-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-253-6287
Provider Business Mailing Address Fax Number:
706-253-6289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 SAMMY MCGHEE BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30143-7703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-253-6287
Provider Business Practice Location Address Fax Number:
706-253-6289
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
KATY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
706-253-6287

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT005450 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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