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General NPI Number Information
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NPI Number | 1700257656
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Entity Type | Organization
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Legal Business Name | A NEW BEGINNING HEALTH SERVICE
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 2562 FAIRBURN RD STE D20
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1465
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Country | US
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Telephone | 770-577-0399
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | AUSTELL
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State | GA
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Zip | 30168-1006
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Country | US
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Telephone | 404-423-0439
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLE EDWARDS
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Credential | DPT
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Telephone | 404-423-0439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | GA
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