Healthcare Provider Details

I. General information

NPI: 1679769582
Provider Name (Legal Business Name): NEW COMMUNITY HORIZON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 LAWRENCEVILLE HWY NW SUITE A
LILBURN GA
30047-2819
US

IV. Provider business mailing address

4025 LAWRENCEVILLE HWY NW SUITE A
LILBURN GA
30047-2819
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-7007
  • Fax: 770-921-7073
Mailing address:
  • Phone: 770-921-7007
  • Fax: 770-921-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number045753
License Number StateGA

VIII. Authorized Official

Name: MS. AVA ALICIA LOVEERING
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-921-7007