Healthcare Provider Details

I. General information

NPI: 1023453214
Provider Name (Legal Business Name): KIMBERLY NILES NEWTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GREEN VALLEY RD DEPARTMENT OF OB GYN
GREENSBORO NC
27408-7021
US

IV. Provider business mailing address

801 GREEN VALLEY RD DEPARTMENT OF OB GYN
GREENSBORO NC
27408-7021
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-6873
  • Fax:
Mailing address:
  • Phone: 336-832-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number192307
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-00730
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: