Provider Demographics
NPI:1801469069
Name:NEWMAN, PAULINE MARY (MS, CNS)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:MARY
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BECKER PLACE NW
Mailing Address - Street 2:UNIT 1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:917-579-6801
Mailing Address - Fax:
Practice Address - Street 1:1 BECKER PLACE NW
Practice Address - Street 2:UNIT 1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307
Practice Address - Country:US
Practice Address - Phone:917-579-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18298133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist