Provider Demographics
NPI:1598314262
Name:NEWSOM, ANNIE SUE
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:SUE
Last Name:NEWSOM
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 1:545 ANN WILSON ROAD
Mailing Address - Street 2:
Mailing Address - City:SEQUATCHIE
Mailing Address - State:TN
Mailing Address - Zip Code:37374
Mailing Address - Country:US
Mailing Address - Phone:423-942-5723
Mailing Address - Fax:
Practice Address - Street 1:545 ANN WILSON ROAD
Practice Address - Street 2:
Practice Address - City:SEQUATCHIE
Practice Address - State:TN
Practice Address - Zip Code:37374
Practice Address - Country:US
Practice Address - Phone:423-942-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider