Provider Demographics
NPI:1790789717
Name:NEWTON, PHILIP THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:THOMAS
Last Name:NEWTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2459
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-0459
Mailing Address - Country:US
Mailing Address - Phone:423-821-1177
Mailing Address - Fax:423-821-1188
Practice Address - Street 1:3812 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1203
Practice Address - Country:US
Practice Address - Phone:423-821-1177
Practice Address - Fax:423-821-1188
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8478208D00000X
GAMD019572208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3169348Medicaid
GA00233285AMedicaid
GA00233285AMedicaid
GA01BDHKFMedicare ID - Type Unspecified
TN3169348Medicare ID - Type Unspecified