Healthcare Provider Details

I. General information

NPI: 1205006210
Provider Name (Legal Business Name): NEWPORT SURGICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 EDENWOOD WAY
PARROTTSVILLE TN
37843
US

IV. Provider business mailing address

890 EDENWOOD WAY
PARROTTSVILLE TN
37843-2554
US

V. Phone/Fax

Practice location:
  • Phone: 423-625-1839
  • Fax: 423-625-2083
Mailing address:
  • Phone: 423-625-1839
  • Fax: 423-625-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MCDONALD GRAY JR.
Title or Position: OWNER/CEO
Credential: MD
Phone: 423-625-1839