Provider Demographics
NPI:1265630834
Name:NEW BEGINNINGS
Entity Type:Organization
Organization Name:NEW BEGINNINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN BLYTHE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP
Authorized Official - Phone:601-749-3887
Mailing Address - Street 1:79 PINK SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8641
Mailing Address - Country:US
Mailing Address - Phone:601-749-3887
Mailing Address - Fax:
Practice Address - Street 1:79 PINK SMITH RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8641
Practice Address - Country:US
Practice Address - Phone:601-749-3887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR606391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS433667051BOtherBLUE CROSS BLUE SHIELD
MS04007878Medicaid
MSP56781Medicare UPIN
MS04007878Medicaid