Provider Demographics
NPI:1457349714
Name:NEWMAN, INGRID RUTH (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:RUTH
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520B JENNINGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2543
Mailing Address - Country:US
Mailing Address - Phone:706-548-1216
Mailing Address - Fax:706-548-1772
Practice Address - Street 1:1520B JENNINGS MILL RD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2543
Practice Address - Country:US
Practice Address - Phone:706-548-1216
Practice Address - Fax:706-548-1772
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA419152080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00709508FMedicaid