Provider Demographics
NPI:1093307845
Name:NEWSOM, MADISON SCOTTIE (PA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:SCOTTIE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:NEWSOM
Other - Last Name:KOSIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1212 ENCLAVE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7440
Mailing Address - Country:US
Mailing Address - Phone:865-850-8452
Mailing Address - Fax:
Practice Address - Street 1:1212 ENCLAVE CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7440
Practice Address - Country:US
Practice Address - Phone:865-850-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant