Provider Demographics
NPI:1104826049
Name:A NEW ME
Entity Type:Organization
Organization Name:A NEW ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:707-935-2799
Mailing Address - Street 1:7715 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2302
Mailing Address - Country:US
Mailing Address - Phone:706-935-2799
Mailing Address - Fax:706-937-5252
Practice Address - Street 1:7715 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2302
Practice Address - Country:US
Practice Address - Phone:706-935-2799
Practice Address - Fax:706-937-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6683200001Medicare PIN