# NEW LEAGUE FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902290570
- **Authorized official:** NATHALIE CELESTIN-WATSON (CREDENTIALING LIAISON/ OWNER)
- **Authorized official phone:** (470) 209-8177

## Contact information

- **Practice address:** 428 WATERBURY DR, LAWRENCEVILLE, GA 30046-3323
- **Practice address phone:** (470) 209-8177
- **Practice address fax:** (678) 310-1550
- **Mailing address:** PO BOX 466607, LAWRENCEVILLE, GA 30042-6607
- **Mailing address phone:** (470) 209-8177
- **Mailing address fax:** (678) 310-1550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/23/2015
- **Last updated:** 01/28/2016