Provider Demographics
NPI:1669934543
Name:NEWSOME, VANESSA E (LMT)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:E
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 HILLSINGER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5418
Mailing Address - Country:US
Mailing Address - Phone:706-825-8176
Mailing Address - Fax:
Practice Address - Street 1:601 N BELAIR SQ
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4321
Practice Address - Country:US
Practice Address - Phone:706-825-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist