Provider Demographics
NPI:1427377597
Name:NEW HORIZONS FAMILY CLINIC
Entity Type:Organization
Organization Name:NEW HORIZONS FAMILY CLINIC
Other - Org Name:MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAZAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-962-0041
Mailing Address - Street 1:667 HERITAGE POST LN
Mailing Address - Street 2:PO BOX 794
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1661
Mailing Address - Country:US
Mailing Address - Phone:770-962-0041
Mailing Address - Fax:
Practice Address - Street 1:667 HERITAGE POST LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1661
Practice Address - Country:US
Practice Address - Phone:770-962-0041
Practice Address - Fax:770-962-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060225261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2047101Medicaid