MEDICARE: DR. JERRY GLYNN NEWMAN JR. 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	2084F0202X	Forensic Psychiatry Physician	40005	TN
2	2084P0800X	Psychiatry Physician	40005	TN

General Provider Information

NPI Number	:	1962401760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY GLYNN NEWMAN JR. MD

Provider Business Mailing Address
First Line	:	2150 N OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3919
Country	:	US
Telephone Number	:	423-614-0122
Fax Number	:	423-478-8235

Provider Business Practice Location Address
First Line	:	2150 N OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3919
Country	:	US
Telephone Number	:	423-614-0122
Fax Number	:	423-478-8235

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/11/2025

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