MEDICARE: TERRY NEWTON MD

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	207P00000X	Emergency Medicine Physician	40751	GA
2	207Q00000X	Family Medicine Physician	040751	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	754400	OTHER	GA	BLUE CROSS

General Provider Information

NPI Number	:	1588691604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY NEWTON MD

Provider Business Mailing Address
First Line	:	62 SWEETWATER CT
Second Line	:
City	:	CATAULA
State	:	GA
Zip	:	31804-4462
Country	:	US
Telephone Number	:	706-596-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 MARTIN LOOP
Second Line	:	DEPARTMENT OF FAMILY MEDICINE
City	:	FORT BENNING
State	:	GA
Zip	:	31905-5647
Country	:	US
Telephone Number	:	706-544-2273
Fax Number	:	706-544-3234

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	01/24/2008

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