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General NPI Number Information
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NPI Number | 1497206726
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Entity Type | Organization
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Legal Business Name | NEWTON FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 1477 TOBIAS GADSON BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-4794
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Country | US
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Telephone | 843-766-7696
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Fax |
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Provider Business Mailing Address
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Address Line | 1477 TOBIAS GADSON BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-4794
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Country | US
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Telephone | 843-766-7696
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ERIC RADABAUGH
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Credential | MBA
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Telephone | 843-364-6695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19206
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License Number State | SC
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