Provider Demographics
NPI:1609232495
Name:NEWHAM, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NEWHAM
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 1:3812 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-5104
Mailing Address - Country:US
Mailing Address - Phone:229-210-1023
Mailing Address - Fax:
Practice Address - Street 1:804 NORTHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1392
Practice Address - Country:US
Practice Address - Phone:229-249-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant