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General NPI Number Information
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NPI Number | 1427377597
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Entity Type | Organization
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Legal Business Name | NEW HORIZONS FAMILY CLINIC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 667 HERITAGE POST LN
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City | GRAYSON
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State | GA
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Zip | 30017-1661
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Country | US
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Telephone | 770-962-0041
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Fax | 770-962-0041
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Provider Business Mailing Address
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Address Line | 667 HERITAGE POST LN PO BOX 794
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City | GRAYSON
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State | GA
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Zip | 30017-1661
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Country | US
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Telephone | 770-962-0041
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Fax |
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Authorized Official
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Title or Position | M.D
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Name | DR. JEAN P. NAZAIRE
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Credential | M.D
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Telephone | 770-962-0041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 060225
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License Number State | GA
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