Provider Demographics
NPI:1730107913
Name:NEWELL, MARY SULLIVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SULLIVAN
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365C CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-4446
Mailing Address - Fax:404-778-4747
Practice Address - Street 1:1365C CLIFTON RD NE
Practice Address - Street 2:SUITE C1104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4446
Practice Address - Fax:404-778-4747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050543174400000X
GA505432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA050543OtherGA. MED. LICENSE