Provider Demographics
NPI:1922119247
Name:NEWSOM, STEVEN KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KEITH
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2010
Mailing Address - Country:US
Mailing Address - Phone:229-247-4996
Mailing Address - Fax:229-259-9029
Practice Address - Street 1:1105 MADISON HWY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5958
Practice Address - Country:US
Practice Address - Phone:229-242-0253
Practice Address - Fax:229-259-9029
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA012344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0556050533Medicare ID - Type Unspecified