Healthcare Provider Details

I. General information

NPI: 1831482314
Provider Name (Legal Business Name): NEW AGE TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 ALPHARETTA HWY SUITE G2
ROSWELL GA
30076-5610
US

IV. Provider business mailing address

11205 ALPHARETTA HWY SUITE G2
ROSWELL GA
30076-5610
US

V. Phone/Fax

Practice location:
  • Phone: 404-831-5479
  • Fax: 678-240-0740
Mailing address:
  • Phone: 404-831-5479
  • Fax: 678-240-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number13739
License Number StateGA

VIII. Authorized Official

Name: MRS. MARCIA JONES
Title or Position: OWNER
Credential:
Phone: 404-831-5479