Provider Demographics
NPI:1295969251
Name:NEWHALL, STANLEY CLARK (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:CLARK
Last Name:NEWHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:799 CLAIRIDGE ELM TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7759
Mailing Address - Country:US
Mailing Address - Phone:801-860-8274
Mailing Address - Fax:
Practice Address - Street 1:799 CLAIRIDGE ELM TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7759
Practice Address - Country:US
Practice Address - Phone:801-860-8274
Practice Address - Fax:801-596-8888
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT169782-1205207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE50128Medicare UPIN