Provider Demographics
NPI:1083128698
Name:NEWTON, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-0326
Mailing Address - Country:US
Mailing Address - Phone:601-894-1120
Mailing Address - Fax:844-270-3071
Practice Address - Street 1:16165 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2002
Practice Address - Country:US
Practice Address - Phone:601-894-1120
Practice Address - Fax:844-270-3071
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07733847376J00000X
MS03734041385H00000X
MS253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03734041Medicaid
MS07733847Medicaid