Provider Demographics
NPI:1619591237
Name:NEWSOM, JANICE (PROVIDER)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200B BUCHANAN ST # 2200B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1912
Mailing Address - Country:US
Mailing Address - Phone:615-609-1472
Mailing Address - Fax:
Practice Address - Street 1:2200B BUCHANAN ST # 2200B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-1912
Practice Address - Country:US
Practice Address - Phone:615-609-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74749216172A00000X
TN13012807172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver