Basic Information
| Provider Information | |||||||||
| NPI: | 1699014068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWMAN | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALLS | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 850 | ||||||||
| Address2: | |||||||||
| City: | ROGERSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378570850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237276319 | ||||||||
| FaxNumber: | 4237274164 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 OAK ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237276319 | ||||||||
| FaxNumber: | 4237274164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2013 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 57011 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.