Provider Demographics
NPI:1962401760
Name:NEWMAN, JERRY GLYNN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:GLYNN
Last Name:NEWMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N OCOEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3919
Mailing Address - Country:US
Mailing Address - Phone:423-614-0122
Mailing Address - Fax:423-478-8235
Practice Address - Street 1:2150 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3919
Practice Address - Country:US
Practice Address - Phone:423-614-0122
Practice Address - Fax:423-478-8235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN400052084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH21733Medicare UPIN