Healthcare Provider Details

I. General information

NPI: 1962636571
Provider Name (Legal Business Name): AMANDA M NEWTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W MAIN ST SUITE 100
BLUE RIDGE GA
30513-7127
US

IV. Provider business mailing address

PO BOX 40
MC CAYSVILLE GA
30555-0040
US

V. Phone/Fax

Practice location:
  • Phone: 706-632-0330
  • Fax: 706-632-9004
Mailing address:
  • Phone: 706-632-0330
  • Fax: 706-632-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number068839
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: