Provider Demographics
NPI:1679769582
Name:NEW COMMUNITY HORIZON, INC
Entity Type:Organization
Organization Name:NEW COMMUNITY HORIZON, INC
Other - Org Name:FAMILY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:LOVEERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-921-7007
Mailing Address - Street 1:4025 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2819
Mailing Address - Country:US
Mailing Address - Phone:770-921-7007
Mailing Address - Fax:770-921-7073
Practice Address - Street 1:4025 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2819
Practice Address - Country:US
Practice Address - Phone:770-921-7007
Practice Address - Fax:770-921-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty