Provider Demographics
NPI:1639355233
Name:NEW FRONTIERS IN HEALTH CARE PC
Entity Type:Organization
Organization Name:NEW FRONTIERS IN HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-869-0501
Mailing Address - Street 1:3675 J DEWEY GRAY CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1868
Mailing Address - Country:US
Mailing Address - Phone:706-869-0501
Mailing Address - Fax:706-868-8375
Practice Address - Street 1:3675 J DEWEY GRAY CIR STE 300
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1868
Practice Address - Country:US
Practice Address - Phone:706-869-0501
Practice Address - Fax:706-868-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDCVMMedicare UPIN
GA08BDFXRMedicare UPIN