Provider Demographics
NPI:1770061442
Name:NEWCOMB, ELIZABETH (DPSC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:DPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-6498
Mailing Address - Country:US
Mailing Address - Phone:855-427-4874
Mailing Address - Fax:855-427-4874
Practice Address - Street 1:102 N CASS ST STE B
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5729
Practice Address - Country:US
Practice Address - Phone:855-427-4874
Practice Address - Fax:855-427-4874
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363520274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty