Organization
NEWSOM HEALTHCARE OF DESOTO COUNTY, LLC
Active
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
Update your record
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