Provider Demographics
NPI:1962025098
Name:NEWSOME, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NEWSOME
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 1:1224 BROACH ST STE 124
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-9344
Mailing Address - Country:US
Mailing Address - Phone:803-398-6982
Mailing Address - Fax:
Practice Address - Street 1:1224 BROACH ST STE 124
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-9344
Practice Address - Country:US
Practice Address - Phone:803-398-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZB0301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiomedical Engineering
No171W00000XOther Service ProvidersContractor
No374700000XNursing Service Related ProvidersTechnician