Healthcare Provider Details

I. General information

NPI: 1609764166
Provider Name (Legal Business Name): MADELYN HERRINGTON NEWMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BRAMPTON AVE
STATESBORO GA
30458-0847
US

IV. Provider business mailing address

801 IRA GRAHAM RD
HAZLEHURST GA
31539-5333
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-3724
  • Fax:
Mailing address:
  • Phone: 912-253-7931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123797
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: