1831482314 NPI number — NEW AGE TESTING 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 1831482314 NPI number — NEW AGE TESTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW AGE TESTING 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:
1831482314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11205 ALPHARETTA HWY
Provider Second Line Business Mailing Address:
SUITE G2
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-5610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-831-5479
Provider Business Mailing Address Fax Number:
678-240-0740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11205 ALPHARETTA HWY
Provider Second Line Business Practice Location Address:
SUITE G2
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-5610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-831-5479
Provider Business Practice Location Address Fax Number:
678-240-0740
Provider Enumeration Date:
05/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-831-5479

Provider Taxonomy Codes

  • Taxonomy code: 175L00000X , with the licence number:  13739 , 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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