Provider Demographics
NPI:1760660203
Name:NEW MEDICAL CENTER PC
Entity Type:Organization
Organization Name:NEW MEDICAL CENTER PC
Other - Org Name:KIDS CARE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NANDLAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAINANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-386-5101
Mailing Address - Street 1:72 KENT RD STE 4
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1695
Mailing Address - Country:US
Mailing Address - Phone:229-386-5101
Mailing Address - Fax:229-386-2277
Practice Address - Street 1:72 KENT RD STE 4
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1695
Practice Address - Country:US
Practice Address - Phone:229-386-5101
Practice Address - Fax:229-386-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63840207Q00000X
GA44893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G701254OtherMEDICARE PTAN
GA7959569408AMedicaid