Healthcare Provider Details

I. General information

NPI: 1467868901
Provider Name (Legal Business Name): MARSHALL FREDERICK NEWMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2014
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-8905
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-9744
  • Fax:
Mailing address:
  • Phone: 706-721-7913
  • Fax: 706-721-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDNF000432
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number8416
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDNGA000836
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12201
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN122283
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: