MEDICARE: ANGELINA LYNN NEWMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	RN225825	GA

General Provider Information

NPI Number	:	1184224321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINA LYNN NEWMAN

Provider Business Mailing Address
First Line	:	196 LAYING FARM RD SE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-9714
Country	:	US
Telephone Number	:	478-414-2343
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 LAYING FARM RD SE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-9714
Country	:	US
Telephone Number	:	478-414-2343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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