Healthcare Provider Details

I. General information

NPI: 1043481682
Provider Name (Legal Business Name): NEWTON HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 HOSPITAL DR NE SUITE 104
COVINGTON GA
30014-2541
US

IV. Provider business mailing address

4181 HOSPITAL DR NE SUITE 104
COVINGTON GA
30014-2541
US

V. Phone/Fax

Practice location:
  • Phone: 770-385-8954
  • Fax: 770-385-8590
Mailing address:
  • Phone: 770-385-8954
  • Fax: 770-385-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number038836
License Number StateGA

VIII. Authorized Official

Name: STEVE DICKSTEIN
Title or Position: CONTROLLER
Credential:
Phone: 770-385-7950