Provider Demographics
NPI:1811143589
Name:NEW HORIZONS FAMILY CLINIC
Entity type:Organization
Organization Name:NEW HORIZONS FAMILY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:770-248-1637
Mailing Address - Street 1:3725 ZOAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6134
Mailing Address - Country:US
Mailing Address - Phone:770-248-1637
Mailing Address - Fax:770-248-1638
Practice Address - Street 1:3725 ZOAR RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6134
Practice Address - Country:US
Practice Address - Phone:770-248-1637
Practice Address - Fax:770-248-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363L00000X
GA133706NP261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811143589OtherMEDICARE GROUP NPI
511G700793OtherMEDICARE GROUP PTAN
GA844105153AMedicaid
GA1043406069Medicare UPIN