Provider Demographics
NPI:1225206741
Name:NEW TRADITIONS IN HEALTH LLC
Entity Type:Organization
Organization Name:NEW TRADITIONS IN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:GEORGIADES
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:772-288-3668
Mailing Address - Street 1:55 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2149
Mailing Address - Country:US
Mailing Address - Phone:772-288-3668
Mailing Address - Fax:
Practice Address - Street 1:55 SE OSCEOLA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2149
Practice Address - Country:US
Practice Address - Phone:772-288-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty