MEDICARE: NEW TRADISTIONS IN HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	AP2141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP2141	OTHER	FL	ACUPUNCTURE

General Provider Information

NPI Number	:	1245433168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW TRADISTIONS IN HEALTH, LLC

Provider Business Mailing Address
First Line	:	2500 QUINCY AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4766
Country	:	US
Telephone Number	:	772-467-9043
Fax Number	:	772-464-6478

Provider Business Practice Location Address
First Line	:	2500 QUINCY AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4766
Country	:	US
Telephone Number	:	772-467-9043
Fax Number	:	772-464-6478

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES N GEORGIADES
Credential	:	DOM
Telephone Number	:	772-467-9043

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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