Provider Demographics
NPI:1205836970
Name:NEWSOM, JOSEPH KERSHAW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KERSHAW
Last Name:NEWSOM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH 'SHAW'
Other - Middle Name:KERSHAW
Other - Last Name:NEWSOM
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-537-2171
Mailing Address - Fax:843-537-5926
Practice Address - Street 1:710 CHESTERFIELD HWY
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7001
Practice Address - Country:US
Practice Address - Phone:843-537-2171
Practice Address - Fax:843-537-5926
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC115182Medicaid
SC115182Medicaid
SCQ26775Medicare UPIN