Healthcare Provider Details

I. General information

NPI: 1306494067
Provider Name (Legal Business Name): REBEKAH DAUGHERTY NEWSOME NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 GA-34 SUITE 1200
NEWNAN GA
30265-3026
US

IV. Provider business mailing address

209 BRIARPATCH CT
STOCKBRIDGE GA
30281-3899
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2121
  • Fax:
Mailing address:
  • Phone: 770-584-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP238317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: