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General NPI Number Information
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NPI Number | 1932355294
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Entity Type | Organization
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Legal Business Name | NEW HORIZONS INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD STE 110
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4317
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Country | US
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Telephone | 770-963-5775
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Fax | 770-476-4533
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Provider Business Mailing Address
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Address Line | 771 OLD NORCROSS RD STE 110
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4317
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Country | US
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Telephone | 770-418-1668
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Fax | 770-476-4533
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Authorized Official
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Title or Position | MBR
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Name | RALPH A JACKSON
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Credential | MD
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Telephone | 770-418-1668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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