Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 12201 | NC |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8416 | SC |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN122283 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DNF000432 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DNGA000836 | GA |
NPI | 1467868901 |
---|---|
Provider Name | Dr. Marshall Frederick Newman |
First Address | Augusta, GA 30912-0001 |
Second Address | Augusta, GA 30912-8905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2014 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003234987B | (05) | GA |
ZX0432 | (05) | SC |