Healthcare Provider Details

I. General information

NPI: 1730811936
Provider Name (Legal Business Name): NU GENESIS INTEGRATIVE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 GROVE PARK DR APT 1704
COLUMBUS GA
31904-1599
US

IV. Provider business mailing address

1448 GROVE PARK DR APT 1704
COLUMBUS GA
31904-1599
US

V. Phone/Fax

Practice location:
  • Phone: 334-744-1137
  • Fax:
Mailing address:
  • Phone: 133-474-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA BODY
Title or Position: OWNER
Credential:
Phone: 334-744-1137