Provider Demographics
NPI:1992217285
Name:NEWBY, DENISE HOLTON (CFM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:HOLTON
Last Name:NEWBY
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 JORDON AVE
Mailing Address - Street 2:
Mailing Address - City:COWARTS
Mailing Address - State:AL
Mailing Address - Zip Code:36321-5634
Mailing Address - Country:US
Mailing Address - Phone:334-797-9273
Mailing Address - Fax:
Practice Address - Street 1:2800 ROSS CLARK CIR STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2039
Practice Address - Country:US
Practice Address - Phone:334-793-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00000000000000000368224900000X
AL368224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty