Provider Demographics
NPI:1154066967
Name:NEWBOLD, ZACHARY EMERSON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:EMERSON
Last Name:NEWBOLD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHIDBY FARM LN
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-0903
Mailing Address - Country:US
Mailing Address - Phone:404-858-3153
Mailing Address - Fax:
Practice Address - Street 1:5948 E LAKE PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4802
Practice Address - Country:US
Practice Address - Phone:404-858-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015299208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation