Healthcare Provider Details

I. General information

NPI: 1689079584
Provider Name (Legal Business Name): JENNIFER NEWSOM HALLFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEE NEWSOM NP-C

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 250
CUMMING GA
30041-7701
US

IV. Provider business mailing address

1400 NORTHSIDE FORSYTH DR STE 250
CUMMING GA
30041-7701
US

V. Phone/Fax

Practice location:
  • Phone: 770-889-7118
  • Fax: 770-844-7835
Mailing address:
  • Phone: 770-889-7118
  • Fax: 770-844-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP192628
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: