Healthcare Provider Details

I. General information

NPI: 1578954350
Provider Name (Legal Business Name): NEW HORIZON MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 1ST AVE
LAWRENCEBURG TN
38464-2762
US

IV. Provider business mailing address

1292 1ST AVE
LAWRENCEBURG TN
38464-2762
US

V. Phone/Fax

Practice location:
  • Phone: 931-244-7461
  • Fax:
Mailing address:
  • Phone: 931-244-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number37386
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35420
License Number StateTN

VIII. Authorized Official

Name: ELAINA MANUELE
Title or Position: CO-MANAGER
Credential:
Phone: 662-417-5475