Provider Demographics
NPI:1578296307
Name:NEW VIALITY
Entity Type:Organization
Organization Name:NEW VIALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-454-4220
Mailing Address - Street 1:711 BROOKWAY BLVD STE A711
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2639
Mailing Address - Country:US
Mailing Address - Phone:601-265-2016
Mailing Address - Fax:601-436-4054
Practice Address - Street 1:711 BROOKWAY BLVD STE A711
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2639
Practice Address - Country:US
Practice Address - Phone:601-265-2016
Practice Address - Fax:601-436-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service