Provider Demographics
NPI:1477864320
Name:WILLIAM T. MAC NEW, JR. MD, PC
Entity Type:Organization
Organization Name:WILLIAM T. MAC NEW, JR. MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAC NEW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-867-4146
Mailing Address - Street 1:314 N BROAD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2191
Mailing Address - Country:US
Mailing Address - Phone:770-867-4146
Mailing Address - Fax:
Practice Address - Street 1:314 N BROAD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2191
Practice Address - Country:US
Practice Address - Phone:770-867-4146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000253756AMedicaid
GA000253756AMedicaid