Provider Demographics
NPI:1487241352
Name:NEWSOME, NOELLE MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:MARIE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MOCKINGBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3976
Mailing Address - Country:US
Mailing Address - Phone:404-432-5940
Mailing Address - Fax:
Practice Address - Street 1:2311 HENRY CLOWER BLVD STE E
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7418
Practice Address - Country:US
Practice Address - Phone:470-306-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily