Basic Information
| Provider Information | |||||||||
| NPI: | 1194446138 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NEWBOLD | ||||||||
| FirstName: | HUGHANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2245 INTERSTATE NORTH PKWY SE UNIT 621 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303392225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148736540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 SANDY PLAINS RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300667210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704385162 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2022 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016240 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.