Provider Demographics
NPI:1174990295
Name:NEWSOME, DAVID JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NEWSOME
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 BRASELTON HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4666
Mailing Address - Country:US
Mailing Address - Phone:770-904-0772
Mailing Address - Fax:
Practice Address - Street 1:3605 BRASELTON HWY STE 101
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4666
Practice Address - Country:US
Practice Address - Phone:770-904-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist