Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | GA000911 | GA |
Y | 222Z00000X | Podiatrist | GA000911 | GA |
NPI | 1033120639 |
---|---|
Provider Name | Dr. Todd Christopher Newsom |
First Address | Savannah, GA 31419-1751 |
Second Address | Savannah, GA 31405-4709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 22/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000927011C | (05) | GA |
205284392 | TAX ID SC (01) | SC |
AA17878685 | (02) | SC |
U86410 | (02) | GA |