=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790168847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER NEW BEGINNINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2015
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 727 W 6TH ST
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30830-4407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-437-0505
-----------------------------------------------------
Fax | 706-554-6219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14067
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30919-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-437-0505
-----------------------------------------------------
Fax | 706-554-6219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | JESSICA MCCORMICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-437-0505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1-14-17565
-----------------------------------------------------
License Number State |
-----------------------------------------------------