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General NPI Number Information
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NPI Number | 1639950108
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Entity Type | Organization
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Legal Business Name | NEW JOURNEY MEDICAL & AESTHETICS
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 2784 N DECATUR RD UNIT 160
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City | DECATUR
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State | GA
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Zip | 30033-5903
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Country | US
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Telephone | 678-383-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 7870 BLEUSPARROW DR
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City | FAIRBURN
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State | GA
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Zip | 30213-6541
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Country | US
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Telephone | 470-905-5162
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | EGRETA STONE
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Credential | NP
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Telephone | 470-905-5162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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