MEDICARE: DR. WYLIE EDWARD NEWTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	064875	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356348759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WYLIE EDWARD NEWTON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	950A S. ENOTA DRIVE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2439
Country	:	US
Telephone Number	:	678-450-8969
Fax Number	:	678-450-8957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/27/2020

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