Basic Information
| Provider Information | |||||||||
| NPI: | 1922114123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW BEGINNINGS FAMILY MEDICAL PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 REYNOIR ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395304109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2287023020 | ||||||||
| FaxNumber: | 2287023025 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 REYNOIR ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395304109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2287023020 | ||||||||
| FaxNumber: | 2287023025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 04/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | SANDOR | ||||||||
| AuthorizedOfficialFirstName: | J. NAOMI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2287023020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 08101394 | 05 | MS | MEDICAID | 04700893 | 05 | MS | MEDICAID |