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General NPI Number Information
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NPI Number | 1386886448
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Entity Type | Organization
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Legal Business Name | NEW LIFESTYLE, INC.
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 2221 PEACHTREE RD NE SUITE D-299
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 678-237-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 PEACHTREE RD NE SUITE D-299
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 678-237-6631
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DIDIER GUTIERREZ
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Credential |
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Telephone | 678-237-6631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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