Provider Demographics
NPI:1639950108
Name:NEW JOURNEY MEDICAL & AESTHETICS
Entity Type:Organization
Organization Name:NEW JOURNEY MEDICAL & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EGRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:470-905-5162
Mailing Address - Street 1:7870 BLEUSPARROW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6541
Mailing Address - Country:US
Mailing Address - Phone:470-905-5162
Mailing Address - Fax:
Practice Address - Street 1:2784 N DECATUR RD UNIT 160
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5903
Practice Address - Country:US
Practice Address - Phone:678-383-1058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1851170138OtherNPI NUMBER