Provider Demographics
NPI:1366482507
Name:CHISM, NEWTON W JR (MD)
Entity Type:Individual
Prefix:
First Name:NEWTON
Middle Name:W
Last Name:CHISM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 BELLEVUE RD
Mailing Address - Street 2:STE 23
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2888
Mailing Address - Country:US
Mailing Address - Phone:478-272-8580
Mailing Address - Fax:478-275-0012
Practice Address - Street 1:2400 BELLEVUE RD
Practice Address - Street 2:#23 ERIN OFFICE PARK
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2885
Practice Address - Country:US
Practice Address - Phone:478-272-8580
Practice Address - Fax:478-275-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0174422084P0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00082233AMedicaid
GA300030912AMedicaid
GA00082233AMedicaid
GAD29133Medicare UPIN
GA300030912AMedicaid