Provider Demographics
NPI:1891082988
Name:NEWTON HEALTH SYSTEM INC DBA PREMIER OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:NEWTON HEALTH SYSTEM INC DBA PREMIER OBSTETRICS AND GYNECOLOGY
Other - Org Name:PREMIER OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF MEDICAL PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-385-4183
Mailing Address - Street 1:10155 EAGLE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3804
Mailing Address - Country:US
Mailing Address - Phone:770-787-4459
Mailing Address - Fax:770-787-8557
Practice Address - Street 1:10155 EAGLE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3804
Practice Address - Country:US
Practice Address - Phone:770-787-4459
Practice Address - Fax:770-787-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038507207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty