Healthcare Provider Details

I. General information

NPI: 1760660203
Provider Name (Legal Business Name): NEW MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 KENT RD STE 4
TIFTON GA
31794-1695
US

IV. Provider business mailing address

72 KENT RD STE 4
TIFTON GA
31794-1695
US

V. Phone/Fax

Practice location:
  • Phone: 229-386-5101
  • Fax: 229-386-2277
Mailing address:
  • Phone: 229-386-5101
  • Fax: 229-386-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63840
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44893
License Number StateGA

VIII. Authorized Official

Name: DR. NANDLAL CHAINANI
Title or Position: CEO
Credential: MD
Phone: 229-386-5101