Provider Demographics
NPI:1174788012
Name:NEWSOME, JOANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:STAPLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30823-0054
Mailing Address - Country:US
Mailing Address - Phone:706-787-9123
Mailing Address - Fax:
Practice Address - Street 1:164 N EASY ST
Practice Address - Street 2:
Practice Address - City:STAPLETON
Practice Address - State:GA
Practice Address - Zip Code:30823-6682
Practice Address - Country:US
Practice Address - Phone:706-787-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037702164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse