Organization
NEWSOM HEALTHCARE OF DESOTO COUNTY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA MATTHEWS NEWSOM FNP (OWNER/PRESIDENT)
(662) 393-8022
Entity
Organization
Contact information
Practice address
2906 GOODMAN RD W, SUITE 109, HORN LAKE, MS 38637-1291
(662) 393-8022
(662) 393-8052
Mailing address
2906 GOODMAN RD W, SUITE 109, HORN LAKE, MS 38637-1291
(662) 393-8022
(662) 393-8052
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R852706
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117535
—
MS
Enumeration date
07/17/2014
Last updated
07/22/2014
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