Provider Demographics
NPI:1760772313
Name:NEWSOME, SHANDA DEJOI (MD)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:DEJOI
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4831
Mailing Address - Country:US
Mailing Address - Phone:229-312-7490
Mailing Address - Fax:
Practice Address - Street 1:1390 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4831
Practice Address - Country:US
Practice Address - Phone:229-312-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine