Healthcare Provider Details

I. General information

NPI: 1467569889
Provider Name (Legal Business Name): MICHAEL NEWBERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 DEPOT ST STE 202
BLUE RIDGE GA
30513-8625
US

IV. Provider business mailing address

311 JUDGES RD
WILMINGTON NC
28405-3651
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-9063
  • Fax: 321-728-1955
Mailing address:
  • Phone: 910-791-6767
  • Fax: 910-399-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME62341
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number72016
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: