| Organization Name: | NEWSOM HEALTHCARE OF DESOTO COUNTY, LLC |
| NPI Number: | 1205243649 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA MATTHEWS NEWSOM (OWNER/PRESIDENT) |
| Mailing Address: | 2906 Goodman Rd W Suite 109 Horn Lake |
| State: | MS US |
| Postal Code: | 386371291 |
| Phone Number: | 6623938022 |
| Fax Number: | 6623938052 |
| NPI Enumeration Date: | 07/17/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R852706 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |