Provider Demographics
NPI:1649444399
Name:NEWBERN & NEWBERN, LLP
Entity type:Organization
Organization Name:NEWBERN & NEWBERN, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:NEWBERN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:229-242-6202
Mailing Address - Street 1:800 NORTHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1392
Mailing Address - Country:US
Mailing Address - Phone:229-242-6202
Mailing Address - Fax:229-245-0155
Practice Address - Street 1:800 NORTHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1392
Practice Address - Country:US
Practice Address - Phone:229-242-6202
Practice Address - Fax:229-245-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental