Provider Demographics
NPI:1326370305
Name:NEWTON MEDICAL FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:NEWTON MEDICAL FAMILY PRACTICE LLC
Other - Org Name:NEWTON HEALTH SYSTEMS INC SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, NEWTON MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-385-4183
Mailing Address - Street 1:5126 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2566
Mailing Address - Country:US
Mailing Address - Phone:770-385-4183
Mailing Address - Fax:770-385-4281
Practice Address - Street 1:7143 TURNER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2066
Practice Address - Country:US
Practice Address - Phone:770-788-9970
Practice Address - Fax:770-788-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty