Healthcare Provider Details

I. General information

NPI: 1043514821
Provider Name (Legal Business Name): TONYA ELAINE NEWSOM L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 THOMPSON BRIDGE RD # 3
GAINESVILLE GA
30501-1663
US

IV. Provider business mailing address

1856 THOMPSON BRIDGE RD # 3
GAINESVILLE GA
30501-1663
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-6907
  • Fax:
Mailing address:
  • Phone: 770-535-6907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001447
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: