Provider Demographics
NPI:1700885910
Name:NEWMAN, GERALD WAYNE JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WAYNE
Last Name:NEWMAN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1567 MILSTEAD RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3835
Mailing Address - Country:US
Mailing Address - Phone:770-483-2291
Mailing Address - Fax:770-483-2927
Practice Address - Street 1:1567 MILSTEAD RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3835
Practice Address - Country:US
Practice Address - Phone:770-483-2291
Practice Address - Fax:770-483-2927
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD000702213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52415558OtherBLUE CROSS BLUE SHIELD
122574162863OtherHUMANA
6141907OtherCIGNA
GA6656OtherCOVENTRY HEALTH CARE
GA48SCBLVMedicare PIN
6141907OtherCIGNA