Organization
NEW LEAGUE FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHALIE CELESTIN-WATSON (CREDENTIALING LIAISON/ OWNER)
(470) 209-8177
Entity
Organization
Contact information
Practice address
428 WATERBURY DR, LAWRENCEVILLE, GA 30046-3323
(470) 209-8177
(678) 310-1550
Mailing address
PO BOX 466607, LAWRENCEVILLE, GA 30042-6607
(470) 209-8177
(678) 310-1550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/23/2015
Last updated
01/28/2016
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