Provider Demographics
NPI:1871207563
Name:NEWBY, NANDI
Entity type:Individual
Prefix:MRS
First Name:NANDI
Middle Name:
Last Name:NEWBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5582 CANNONADE LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5919
Mailing Address - Country:US
Mailing Address - Phone:504-407-4742
Mailing Address - Fax:
Practice Address - Street 1:2795 MAIN ST W STE 19A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3072
Practice Address - Country:US
Practice Address - Phone:725-715-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health