Provider Demographics
NPI:1730551052
Name:NEW AWAKENINGS, LLC
Entity type:Organization
Organization Name:NEW AWAKENINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANSHUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JYOTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-438-9091
Mailing Address - Street 1:4440 VIKING DR
Mailing Address - Street 2:SUITE 300-400
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7511
Mailing Address - Country:US
Mailing Address - Phone:318-584-7137
Mailing Address - Fax:
Practice Address - Street 1:4440 VIKING DR
Practice Address - Street 2:SUITE 300-400
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7511
Practice Address - Country:US
Practice Address - Phone:318-584-7137
Practice Address - Fax:318-584-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2041392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty