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General NPI Number Information
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NPI Number | 1528519113
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Entity Type | Organization
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Legal Business Name | A NEW JOURNEY
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 4100 CADILLAC CT
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City | LOUISVILLE
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State | KY
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Zip | 40213-1591
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Country | US
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Telephone | 724-766-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 CADILLAC CT
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City | LOUISVILLE
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State | KY
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Zip | 40213-1591
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Country | US
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Telephone | 724-766-9578
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | ALLEN SPERRY
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Credential |
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Telephone | 859-940-4987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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