Provider Demographics
NPI:1992823488
Name:NEWSOME, ATLAS EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:ATLAS
Middle Name:EUGENE
Last Name:NEWSOME
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 1:1819 ROCKROSE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-9298
Mailing Address - Country:US
Mailing Address - Phone:910-717-8491
Mailing Address - Fax:
Practice Address - Street 1:931 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0000
Practice Address - Country:US
Practice Address - Phone:910-717-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist