Provider Demographics
NPI:1194446138
Name:NEWBOLD, HUGHANDRA
Entity type:Individual
Prefix:
First Name:HUGHANDRA
Middle Name:
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 INTERSTATE NORTH PKWY SE UNIT 621
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2225
Mailing Address - Country:US
Mailing Address - Phone:814-873-6540
Mailing Address - Fax:
Practice Address - Street 1:2550 SANDY PLAINS RD STE 140
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7210
Practice Address - Country:US
Practice Address - Phone:770-438-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist