Healthcare Provider Details

I. General information

NPI: 1730856865
Provider Name (Legal Business Name): MRS. AMY CATHERINE NEWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 AVALON BLVD
CONYERS GA
30013-6320
US

IV. Provider business mailing address

3240 AVALON BLVD
CONYERS GA
30013-6320
US

V. Phone/Fax

Practice location:
  • Phone: 770-860-1133
  • Fax:
Mailing address:
  • Phone: 770-860-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN203120
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: