Provider Demographics
NPI:1942239504
Name:INTERNAL MEDICINE OF NEWTON CO
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF NEWTON CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:STILLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-787-2399
Mailing Address - Street 1:4181 HOSPITAL DR NE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:770-787-2399
Mailing Address - Fax:770-784-0435
Practice Address - Street 1:4181 HOSPITAL DR NE
Practice Address - Street 2:SUITE 401
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-787-2399
Practice Address - Fax:770-784-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACE7236OtherRAILROAD MEDICARE
GAGRP3131Medicare PIN