Healthcare Provider Details

I. General information

NPI: 1437470150
Provider Name (Legal Business Name): JIMMIE ISAAC NEWTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 LATROBE DR
CHARLOTTE NC
28211-4845
US

IV. Provider business mailing address

2853 SILAS RIDGE RD
WINSTON SALEM NC
27106-5000
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-7415
  • Fax:
Mailing address:
  • Phone: 336-682-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number14269
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: