Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 064875 | GA |
NPI | 1356348759 |
---|---|
Provider Name | Dr. Wylie Edward Newton |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-2439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TO BE DETERMINED | (05) | GA |